Provider Demographics
NPI:1396619441
Name:STANSBURY, JESSICA HERMINIA (RDH)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:HERMINIA
Last Name:STANSBURY
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 PENNY LN
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-1508
Mailing Address - Country:US
Mailing Address - Phone:774-432-1188
Mailing Address - Fax:
Practice Address - Street 1:13 PENNY LN
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-1508
Practice Address - Country:US
Practice Address - Phone:774-432-1188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-01
Last Update Date:2025-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADH100067124Q00000X
MERDH4626124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist