Provider Demographics
NPI:1174917629
Name:PEELE, JESSICA (DDS)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:PEELE
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 1:1174 LEESVILLE ST
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29405-4741
Mailing Address - Country:US
Mailing Address - Phone:919-360-6882
Mailing Address - Fax:
Practice Address - Street 1:1174 LEESVILLE ST
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29405-4741
Practice Address - Country:US
Practice Address - Phone:919-360-6882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-23
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCDGD.8762 GD122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist