# DR. RONALD DEAN JESSUP

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1184813164
- **Gender:** Man
- **Credential:** D.M.D.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 0401008645 | VA | Yes |

## Other

- **Enumeration date:** 10/16/2007
- **Last updated:** 10/28/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 00701762 | UNITED CONCORDIA | VA |
| 05 | — | 007800568 | — | VA |
| 01 | — | 041008645A | DELTA DENTAL | VA |