Individual
DR. JESSICA TAILING DESOUZA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
123 7TH AVE, 108, BROOKLYN, NY 11215-1301
(917) 204-0961
Mailing address
123 7TH AVE, 108, BROOKLYN, NY 11215-1301
(917) 204-0961
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
055570-1
NY
Other
Enumeration date
06/08/2010
Last updated
09/02/2014
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