Provider Demographics
NPI:1699345694
Name:EISENBERG, JESSICA (DDS, MSD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:EISENBERG
Suffix:
Gender:F
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15810 NORTHCROSS DR STE A
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-5070
Mailing Address - Country:US
Mailing Address - Phone:704-909-4566
Mailing Address - Fax:
Practice Address - Street 1:15810 NORTHCROSS DR STE A
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-5070
Practice Address - Country:US
Practice Address - Phone:704-909-4566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-30
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401417538122300000X
NC140051223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist