Provider Demographics
NPI:1972240331
Name:GOSEY, JASMIN LESHAWN (DDS)
Entity type:Individual
Prefix:
First Name:JASMIN
Middle Name:LESHAWN
Last Name:GOSEY
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 1:1111 E I65 SERVICE RD S STE 104-1200
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36606-3112
Mailing Address - Country:US
Mailing Address - Phone:504-875-0192
Mailing Address - Fax:
Practice Address - Street 1:1651 SCHILLINGER RD N
Practice Address - Street 2:
Practice Address - City:SEMMES
Practice Address - State:AL
Practice Address - Zip Code:36575-7409
Practice Address - Country:US
Practice Address - Phone:251-706-7960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-17
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALD.007311-C11223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry