Provider Demographics
NPI:1336719830
Name:DANDRIDGE, JALEESA BRIGHT (DMD)
Entity type:Individual
Prefix:
First Name:JALEESA
Middle Name:BRIGHT
Last Name:DANDRIDGE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 W 5TH ST STE 120
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-5363
Mailing Address - Country:US
Mailing Address - Phone:512-617-0101
Mailing Address - Fax:512-505-8151
Practice Address - Street 1:1011 W 5TH ST STE 120
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78703-5363
Practice Address - Country:US
Practice Address - Phone:512-617-0101
Practice Address - Fax:512-505-8151
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-28
Last Update Date:2025-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX420301223G0001X
MS4223-21122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist