Individual
DR. GREGORY SHANE JESSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1508 E SKYLINE DR STE 800, OGDEN, UT 84405-4889
(801) 479-8200
(801) 479-3219
Mailing address
1508 E SKYLINE DR STE 800, OGDEN, UT 84405-4889
(801) 479-8200
(801) 479-3219
Taxonomy
Speciality
Code
Description
License number
State
1223D0004X
Dental Anesthesiology
5219929-9924
UT
1223P0106X
Oral and Maxillofacial Pathology Dentistry
52199299924
UT
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
5219929-9924
UT
Other
Enumeration date
11/03/2006
Last updated
10/17/2023
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