Provider Demographics
NPI:1487303723
Name:MILLIKEN, JESSICA ROSE (DMD)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:ROSE
Last Name:MILLIKEN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:MRS
Other - First Name:JESSICA
Other - Middle Name:ROSE
Other - Last Name:BOUCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11100 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44106-1716
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:182 CENTRAL ST
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:NH
Practice Address - Zip Code:03051-4651
Practice Address - Country:US
Practice Address - Phone:603-882-5455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-23
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH05079122300000X, 1223E0200X
MADN18595441223E0200X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist