Jesse Whitely DDS, Inc

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

59369 Issued in CA

Legal business name

JESSE WHITELY DDS, INC

Practice address

3113 Professional Dr
Auburn, CA 95603-2459

Phone

(530) 885-6559

Fax

(530) 885-4142

NPI assigned

Aug 5, 2018

Last updated

Dec 23, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Jesse Ryan Whitely, DDSNPI 1720391162

Title

President

Phone

(530) 885-6559

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jesse R Whitely, DDS

  • General Practice Dentistry
  • Auburn, CA
  • NPI 1720391162
  NPD Authorized official
• Paul Russel Kodet, DDS

  • Dentist
  • Auburn, CA
  • NPI 1417065293
  NPD (past)

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

{
    "created_epoch": "1533427200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1640217600000",
    "number": "1972081545",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3113 PROFESSIONAL DR",
            "city": "AUBURN",
            "state": "CA",
            "postal_code": "956032459",
            "telephone_number": "530-885-6559",
            "fax_number": "530-885-4142"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3113 PROFESSIONAL DR",
            "city": "AUBURN",
            "state": "CA",
            "postal_code": "956032459",
            "telephone_number": "530-885-6559",
            "fax_number": "530-885-4142"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JESSE WHITELY DDS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-05",
        "last_updated": "2021-12-23",
        "certification_date": "2021-12-23",
        "status": "A",
        "authorized_official_last_name": "WHITELY",
        "authorized_official_first_name": "JESSE",
        "authorized_official_middle_name": "RYAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "530-885-6559",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "CA",
            "license": "59369",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeffrey R Jenkins, M.D.
• Kaila Jenkins
• Jennifer Jensen, RN, PHN
• Leah Jensen
• Marla Jean Jensen, LCSW
• Patrick Jew, MS,PT
• Marcia Johanson, P.T.
• Jugraj Singh Johl, PHARM D
• Becca D. Johnson, OT
• David C Johnson

• Dental Clinic/Center in Auburn, CA
• Providers in Auburn, CA by specialty
• Dental Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.