Brett Jessen

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

DEN.00205787 Issued in CO

Practice address

10TH Medical Group
4102 Pinion Drive
Usaf Academy, CO 80840

Phone

(801) 721-6846

NPI assigned

Feb 13, 2016

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1455321600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697500800000",
    "number": "1104285543",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10TH MEDICAL GROUP",
            "address_2": "4102 PINION DRIVE",
            "city": "USAF ACADEMY",
            "state": "CO",
            "postal_code": "80840"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10TH MEDICAL GROUP",
            "address_2": "4102 PINION DRIVE",
            "city": "USAF ACADEMY",
            "state": "CO",
            "postal_code": "80840",
            "telephone_number": "801-721-6846"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "37938 Brutus Way",
            "address_purpose": "LOCATION",
            "city": "Beaumont",
            "state": "CA",
            "postal_code": "922238049",
            "country_code": "US",
            "telephone_number": "801-721-6846",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2133 Pepperrell St",
            "address_purpose": "LOCATION",
            "city": "Lackland AFB",
            "state": "TX",
            "postal_code": "782365313",
            "country_code": "US",
            "telephone_number": "801-721-6846",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JESSEN",
        "first_name": "BRETT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-02-13",
        "last_updated": "2023-10-17",
        "certification_date": "2023-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "CO",
            "license": "DEN.00205787",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "CO",
            "license": "DEN.00205787",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tracy Hoover, AUD
• Scott C. Hughes
• Holly R Ingram, DO
• Jonathan Clayton Jackson, M.D.
• Shari Szucs Jacobson, ATC
• Hillary Shea Johnson, PHARMD
• Kellie Ann Jones, DMD
• Brian Robert Kennedy, DNP
• David A Kephart Jr., D.O.
• Stacy Keser

• Periodontics in Usaf Academy, CO
• Providers in Usaf Academy, CO by specialty
• Periodontics in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.