Jessica Suhardjo, DMD, MS

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

DDS108563 Issued in CA

Practice address

15290 Bear Valley Rd Ste B
Victorville, CA 92395-8515

Phone

(760) 493-3215

NPI assigned

Oct 18, 2023

Last updated

Oct 18, 2023By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1697587200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697587200000",
    "number": "1518749050",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2167 N 1ST AVE",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917841446",
            "telephone_number": "909-331-8445"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15290 BEAR VALLEY RD STE B",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923958515",
            "telephone_number": "760-493-3215"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4834 Etiwanda Ave Ste 200",
            "address_purpose": "LOCATION",
            "city": "Jurupa Valley",
            "state": "CA",
            "postal_code": "917521828",
            "country_code": "US",
            "telephone_number": "951-688-7249",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SUHARDJO",
        "first_name": "JESSICA",
        "name_prefix": "Dr.",
        "credential": "DMD, MS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-10-18",
        "last_updated": "2023-10-18",
        "certification_date": "2023-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "CA",
            "license": "DDS108563",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shirley Ann Stutson, MFT
• Luisa Suarez
• Patricia Suarez
• Yash P Subherwal, MD
• Hae Young Suh
• Sujal Parikh DDS, Inc (Mojave Dental Center)
• Victor F. Sulit, MD, MPH
• Mary L. Sullivan-Tansey, R.N., M.F.T., PSY. D
• Cheyenne Tey Sullivan
• Shelby Rose Sullivan

• Orthodontics and Dentofacial Orthopedics Dentistry in Victorville, CA
• Providers in Victorville, CA by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in California

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