Individual
JESSICA GONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4410 ARAPAHOE AVE STE 230, BOULDER, CO 80303-1198
(303) 442-4555
Mailing address
536 W 174TH AVE, BROOMFIELD, CO 80023-5206
(770) 596-6827
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DEN.00204879
CO
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/25/2020
Last updated
07/23/2025
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