Individual
DR. JESSICA MICHELLE LISTWA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
645 MAIN ST, HACKENSACK, NJ 07601
(201) 488-5953
Mailing address
5 LEFFERTS CT, EAST BRUNSWICK, NJ 08816-3225
(908) 208-1700
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
22D102721100
NJ
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/18/2016
Last updated
04/03/2019
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