Provider Demographics
NPI:1528627254
Name:KESSLER, JEANETTE (DMD)
Entity type:Individual
Prefix:DR
First Name:JEANETTE
Middle Name:
Last Name:KESSLER
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 1:7468 MID BROADWELL TRCE
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-1442
Mailing Address - Country:US
Mailing Address - Phone:678-787-0129
Mailing Address - Fax:
Practice Address - Street 1:1234 S HAIRSTON RD
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30088-2719
Practice Address - Country:US
Practice Address - Phone:678-787-0129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-06
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0158511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice