Provider Demographics
NPI:1316693567
Name:SUEDBECK, JESSICA (RDH, MSDH)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:SUEDBECK
Suffix:
Gender:F
Credentials:RDH, MSDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4608 HAMPTON BOULEVARD
Mailing Address - Street 2:HEALTH SCIENCES BUILDING ROOM 1101 C
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23529-0001
Mailing Address - Country:US
Mailing Address - Phone:757-683-4804
Mailing Address - Fax:
Practice Address - Street 1:4608 HAMPTON BOULEVARD
Practice Address - Street 2:HEALTH SCIENCES BUILDING ROOM 1101 C
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23529-0001
Practice Address - Country:US
Practice Address - Phone:757-683-4804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-25
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0402206383124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist