Provider Demographics
NPI:1932340536
Name:POE, JESSICA WINTER (DDS)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:WINTER
Last Name:POE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19001NORTH TAMIAMI TRAIL
Mailing Address - Street 2:SUITE #3171
Mailing Address - City:NORTH FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33903
Mailing Address - Country:US
Mailing Address - Phone:239-731-8811
Mailing Address - Fax:239-731-2016
Practice Address - Street 1:19001NORTH TAMIAMI TRAIL
Practice Address - Street 2:SUITE #3171
Practice Address - City:NORTH FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33903
Practice Address - Country:US
Practice Address - Phone:239-731-8811
Practice Address - Fax:239-731-2016
Is Sole Proprietor?:No
Enumeration Date:2009-03-12
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN174461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice