Talitha Marie Jesse

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D012005 Issued in AZ

Practice address

4550 E Bell Rd Ste 106
Phoenix, AZ 85032-9342

Phone

(602) 344-9530

NPI assigned

Jun 28, 2016

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Other names 1

• Talitha Marie Jesse Khorasani Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Pacific Dental Services Foundation

  • Medical Physician Assistant
  • Phoenix, AZ
  • NPI 1659848208
  NPD
• Center for Learning and Autism Support Services, Inc.

  • Early Intervention Provider Agency
  • San Mateo, CA
  • NPI 1417139288

  Behavior Analyst

  NPD (past)

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

{
    "created_epoch": "1467072000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726704000000",
    "number": "1669823829",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16333 RIDGEHAVEN DR UNIT 1002",
            "city": "SAN LEANDRO",
            "state": "CA",
            "postal_code": "945781481",
            "telephone_number": "925-719-0019"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4550 E BELL RD STE 106",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850329342",
            "telephone_number": "602-344-9530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JESSE",
        "first_name": "TALITHA",
        "middle_name": "MARIE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-06-28",
        "last_updated": "2024-09-19",
        "certification_date": "2024-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "108674",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "AZ",
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AZ",
            "license": "D012005",
            "primary": true
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TALITHA",
            "last_name": "KHORASANI",
            "middle_name": "MARIE JESSE",
            "credential": "DDS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Samantha Jerome, RDN, CDCES, LRD
• Tatiana Jerome, MD
• Jesa Homes LLC
• Jesa Homes LLC
• Patricia Jesse I
• Colleen R Jessessky, RD
• Jessica Cruz Psychiatric Services, LLC
• Brittney Paige Jessick, PSY.D.
• Baronnie Jeremiah Jessie, MSW
• Sophie Shizuyo Jessop, PA-C

• All providers in Phoenix, AZ
• General Practice Dentistry in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2024; 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.