Provider Demographics
NPI:1992048961
Name:PICKEL, JESSICA (DENTAL HYGENTIST)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:PICKEL
Suffix:
Gender:F
Credentials:DENTAL HYGENTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 400
Mailing Address - Street 2:
Mailing Address - City:NEW MADRID
Mailing Address - State:MO
Mailing Address - Zip Code:63869-0400
Mailing Address - Country:US
Mailing Address - Phone:573-748-2404
Mailing Address - Fax:573-748-2554
Practice Address - Street 1:6724 STATE HIGHWAY 77
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:MO
Practice Address - Zip Code:63736-8238
Practice Address - Country:US
Practice Address - Phone:573-545-4191
Practice Address - Fax:573-545-4425
Is Sole Proprietor?:No
Enumeration Date:2013-03-28
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006038578124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist