Provider Demographics
NPI:1699294488
Name:DUFFORD, JESSICA A (RDH)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:A
Last Name:DUFFORD
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:A
Other - Last Name:QUICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9 CAREY RD
Mailing Address - Street 2:
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804-7880
Mailing Address - Country:US
Mailing Address - Phone:518-761-0300
Mailing Address - Fax:518-824-2388
Practice Address - Street 1:9 CAREY RD
Practice Address - Street 2:
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804-7880
Practice Address - Country:US
Practice Address - Phone:518-761-0300
Practice Address - Fax:518-824-2388
Is Sole Proprietor?:No
Enumeration Date:2017-09-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025351124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist