Jessica Breedlove, DDS
Individual provider Active NPI Dentist · Tucker, AR
NPI 1124410097 · NPPES record last updated Mar 2, 2015
Key facts
- NPI
- 1124410097
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 3519 (AR)
- Practice address
- 2400 State Farm Rd
Tucker, AR 72168-9503 - Phone
- (901) 289-3593
- NPI assigned
- Mar 2, 2015
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3519 | AR | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 3519 | AR | Yes |
Addresses
Primary practice location
2400 State Farm Rd
Tucker, AR 72168-9503
Mailing address
2400 State Farm Rd
Tucker, AR 72168-9503
Phone (901) 289-3593
Other providers in Tucker, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 2, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.