Individual
JESSICA SATHISSARAT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
88 MDG/SGHJ, 4881 SUGAR MAPLE DR. BLDG 830, WRIGHT-PATTERSON AFB, OH 45433-5529
(937) 257-0500
Mailing address
13555 GOLDEN MEADOW DR, PLAINFIELD, IL 60544-9671
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
019.028641
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
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Other
Enumeration date
03/23/2011
Last updated
07/06/2023
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