Individual
DR. RONALD DEAN JESSUP
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
14245 LEE HWY, BRISTOL, VA 24202-4317
(276) 628-8164
(276) 644-3145
Mailing address
14245 LEE HWY, BRISTOL, VA 24202-4317
(276) 628-8164
(276) 644-3145
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
0401008645
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00701762
UNITED CONCORDIA
VA
05
—
007800568
—
VA
01
—
041008645A
DELTA DENTAL
VA
Enumeration date
10/16/2007
Last updated
10/28/2010
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