Provider Demographics
NPI:1679158356
Name:WHITE, JESSLYN LENA GRACE (DDS)
Entity type:Individual
Prefix:
First Name:JESSLYN
Middle Name:LENA GRACE
Last Name:WHITE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 21ST PL
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-4407
Mailing Address - Country:US
Mailing Address - Phone:310-489-9208
Mailing Address - Fax:
Practice Address - Street 1:455 E COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-1602
Practice Address - Country:US
Practice Address - Phone:562-933-3141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-14
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1070421223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry