Jessica Marie Desjardins, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D12677 Issued in MN

Practice address

250 Central Ave N Ste 202
Wayzata, MN 55391-1208

Phone

(952) 473-4900

NPI assigned

Jun 18, 2009

Last updated

Oct 24, 2011By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Wayzata Dental, LTD.

  dba Wayzata Dental

  • General Practice Dentistry
  • Wayzata, MN
  • NPI 1659554517
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1245283200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1319414400000",
    "number": "1033346986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9700 WATERSTONE PL APT 217A",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553055541",
            "telephone_number": "612-807-6658"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 CENTRAL AVE N STE 202",
            "city": "WAYZATA",
            "state": "MN",
            "postal_code": "553911208",
            "telephone_number": "952-473-4900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DESJARDINS",
        "first_name": "JESSICA",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-06-18",
        "last_updated": "2011-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D12677",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Luc Rene De la Villefromoy, DDS, MS
• Deephaven Chiropractic, P.a.
• Deephaven Phcy Inc (Deephaven Drug Co)
• Dental Specialist of Minnesota, PLLC (The Dental Specialist Deephaven)
• Elizabeth Deshler
• Luciana Alexandra Di Biagio, MSW, LGSW
• Distinctive Eyewear LLC (Northwest Eyewear)
• Dr. Daniel S. Tierney, LLC (Tierney Chiropractic)
• Lucas G Dueffert, P.T
• Duffey Black Counseling and Care Managment of Wayzata, LLC

• General Practice Dentistry in Wayzata, MN
• Providers in Wayzata, MN by specialty
• General Practice Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.