Individual
JESSICA THAYER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
1048 UNION ST, BANGOR, ME 04401-3016
(207) 404-8200
(207) 947-0435
Mailing address
1090 E WELDON AVE, PHOENIX, AZ 85014-5046
(928) 301-4442
(505) 899-4804
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
D009928
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DEN4740
STATE LICENSE
ME
Enumeration date
08/09/2018
Last updated
07/26/2019
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