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Individual
DR. GREGORY SHANE JESSEN
Active
Individual
DR. GREGORY SHANE JESSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Taxonomy
Speciality
Code
Description
License number
State
1223D0004X
Dental Anesthesiology
5219929-9924
UT
1223P0106X
Oral and Maxillofacial Pathology Dentistry
52199299924
UT
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
5219929-9924
UT
Other
Enumeration date
11/03/2006
Last updated
10/17/2023
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