Provider Demographics
NPI:1720547268
Name:STARNES, JESSICA LAUREN (DMD)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:LAUREN
Last Name:STARNES
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 1:449 MEADOWLARK ST # 1046
Mailing Address - Street 2:
Mailing Address - City:SHAW AFB
Mailing Address - State:SC
Mailing Address - Zip Code:29152-5020
Mailing Address - Country:US
Mailing Address - Phone:845-304-2024
Mailing Address - Fax:
Practice Address - Street 1:449 MEADOWLARK ST # 1046
Practice Address - Street 2:
Practice Address - City:SHAW AFB
Practice Address - State:SC
Practice Address - Zip Code:29152-5020
Practice Address - Country:US
Practice Address - Phone:803-895-6988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-14
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
SC9429122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program