Provider Demographics
NPI:1073840153
Name:MACE, JAYME M (DMD)
Entity Type:Individual
Prefix:DR
First Name:JAYME
Middle Name:M
Last Name:MACE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 S CASCADE ST
Mailing Address - Street 2:
Mailing Address - City:FERGUS FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56537-2803
Mailing Address - Country:US
Mailing Address - Phone:187-363-1792
Mailing Address - Fax:218-737-0618
Practice Address - Street 1:323 S CASCADE ST
Practice Address - Street 2:
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537-2803
Practice Address - Country:US
Practice Address - Phone:218-736-3179
Practice Address - Fax:218-737-0618
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-10
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN127701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice