Individual
JESSICA MAE ELLSPERMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
2186 N HOSPITAL BLVD # 1, SULLIVAN, IN 47882-7654
(812) 268-4010
Mailing address
10812 N OLD 41, OAKTOWN, IN 47561-8015
(812) 499-3465
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12012696B
IN
Other
Enumeration date
06/06/2017
Last updated
06/06/2017
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