| Jesse Whitely DDS, Inc | |
|
3113 Professional Dr Auburn CA 95603-2459 | |
| (530) 885-6559 | |
| (530) 885-4142 |
| Full Name | Jesse Whitely DDS, Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 3113 Professional Dr, Auburn, California |
| Authorized Official Name and Position | Jesse Ryan Whitely (PRESIDENT) |
| Authorized Official Contact | 5308856559 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jesse Whitely DDS, Inc 3113 Professional Dr Auburn CA 95603-2459 Ph: (530) 885-6559 | Jesse Whitely DDS, Inc 3113 Professional Dr Auburn CA 95603-2459 Ph: (530) 885-6559 |
| NPI Number | 1972081545 |
|---|---|
| Provider Enumeration Date | 08/05/2018 |
| Last Update Date | 12/23/2021 |
| Certification Date | 12/23/2021 |
| Medicare PECOS PAC ID | 9234560681 |
|---|---|
| Medicare Enrollment ID | O20200519001304 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972081545 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 59369 (California) | Primary |
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