Individual
MRS. JESSICA MARIE SOUTHEARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.D.H
Contact information
Practice address
10205 N RIVA RIDGE LOOP, FORT DRUM, NY 13602-5457
(315) 772-8843
Mailing address
10205 N RIVA RIDGE LOOP, FORT DRUM, NY 13602-5457
(315) 772-8843
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
7426 C1
AL
Other
Enumeration date
05/04/2012
Last updated
07/22/2013
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