Provider Demographics
NPI:1033281027
Name:JESSOP, JALEENA ANN (DDS)
Entity type:Individual
Prefix:MRS
First Name:JALEENA
Middle Name:ANN
Last Name:JESSOP
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9829 S 1300 E STE 201
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84094-4025
Mailing Address - Country:US
Mailing Address - Phone:801-569-2600
Mailing Address - Fax:
Practice Address - Street 1:9829 S 1300 E STE 201
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84094-4025
Practice Address - Country:US
Practice Address - Phone:801-569-2600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT51122121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice