Individual
TALITHA MARIE JESSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4550 E BELL RD STE 106, PHOENIX, AZ 85032-9342
(602) 344-9530
Mailing address
16333 RIDGEHAVEN DR UNIT 1002, SAN LEANDRO, CA 94578-1481
(925) 719-0019
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
—
—
122300000X
Dentist
108674
CA
1223G0001X
General Practice Dentistry
Primary
D012005
AZ
390200000X
Student in an Organized Health Care Education/Training Program
—
AZ
Other
Enumeration date
06/28/2016
Last updated
09/19/2024
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