Jessica Nicole Hagan, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

11205 Issued in TN

Practice address

875 Union Ave
Memphis, TN 38163-1030

Phone

(510) 566-3802

NPI assigned

Feb 10, 2016

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other names 1

• Ms. Jessica Nicole Houghton Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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

• Dr Donna Michelle Gentry DDS PLLC

  • Dental Clinic/Center
  • Cedar Point, NC
  • NPI 1497260707
  NPD (past)

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

{
    "created_epoch": "1455062400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1608249600000",
    "number": "1427417070",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2834 HONEY TREE DR",
            "city": "GERMANTOWN",
            "state": "TN",
            "postal_code": "381387210",
            "telephone_number": "510-566-3802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "875 UNION AVE",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381631030",
            "telephone_number": "510-566-3802"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "420 W Watkins Rd",
            "address_purpose": "LOCATION",
            "city": "Phoenix",
            "state": "AZ",
            "postal_code": "850032830",
            "country_code": "US",
            "telephone_number": "602-261-8686",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1165 Cedar Point Blvd Ste P",
            "address_purpose": "LOCATION",
            "city": "Cedar Point",
            "state": "NC",
            "postal_code": "285841030",
            "country_code": "US",
            "telephone_number": "252-764-2784",
            "fax_number": "252-764-2784",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HAGAN",
        "first_name": "JESSICA",
        "middle_name": "NICOLE",
        "name_prefix": "Mrs.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-02-10",
        "last_updated": "2020-12-18",
        "certification_date": "2020-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "NC",
            "license": "10747",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TN",
            "license": "11205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JESSICA",
            "last_name": "HOUGHTON",
            "middle_name": "NICOLE",
            "prefix": "MS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Ann Michele Hadley, BS, RRT, CPFT
• Candace Hadley, LMSW
• Aqsa Hafeez
• Sarah Hafner, LPC-MHSP
• Deana Hagaman, CRNA
• Gerald David-Allen Hagler II, MD
• Cyrine Haidar, PHARMD
• Melate Tenaye Haile
• Jasmine Danielle Hailey
• Taquisa Hailey

• Dentist in Memphis, TN
• Providers in Memphis, TN by specialty
• Dentist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2020; 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.