Provider Demographics
NPI:1043280183
Name:CALHOUN-JAMISON, STEPHANIE NMI (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:NMI
Last Name:CALHOUN-JAMISON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:STEPHANIE
Other - Middle Name:NMI
Other - Last Name:CALHOUN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:577 STERNBERG AVE
Mailing Address - Street 2:
Mailing Address - City:FORT EUSTIS
Mailing Address - State:VA
Mailing Address - Zip Code:23604-1526
Mailing Address - Country:US
Mailing Address - Phone:757-314-7980
Mailing Address - Fax:
Practice Address - Street 1:577 STERNBERG AVE
Practice Address - Street 2:
Practice Address - City:FORT EUSTIS
Practice Address - State:VA
Practice Address - Zip Code:23604-1526
Practice Address - Country:US
Practice Address - Phone:757-314-7980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0116511223G0001X, 1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
BC7043071OtherFEDERAL DEA