Individual
JESS JORDAN CAYETANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1100 WILFORD HALL LOOP BLDG 4554, JBSA LACKLAND, TX 78236-5638
(210) 292-0690
Mailing address
1100 WILFORD HALL LOOP BLDG 4554, JBSA LACKLAND, TX 78236-5638
(210) 292-0690
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DE6132122
WA
1223G0001X
General Practice Dentistry
DE61302122
WA
390200000X
Student in an Organized Health Care Education/Training Program
DE61302122
WA
Other
Enumeration date
04/20/2022
Last updated
08/07/2023
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