Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 12012195A | IN |
NPI | 1003225467 |
---|---|
Provider Name | Dr. Jessica June Ginter |
First Address | South Bend, IN 46635-1529 |
Second Address | South Bend, IN 46635-1529 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2014 |
Last Update Date | 23/10/2018 |