Provider Demographics
NPI:1366253916
Name:ZHU, JESSIE (DMD MS)
Entity type:Individual
Prefix:DR
First Name:JESSIE
Middle Name:
Last Name:ZHU
Suffix:
Gender:F
Credentials:DMD MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 GREEN BAY RD # W303
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-3136
Mailing Address - Country:US
Mailing Address - Phone:859-433-5442
Mailing Address - Fax:
Practice Address - Street 1:810 S WAUKEGAN RD STE 101
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-2672
Practice Address - Country:US
Practice Address - Phone:847-615-5437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-14
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0356771223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics