Provider Demographics
NPI:1093240152
Name:JAIME A. ABBOTT, DDS, PLLC
Entity Type:Organization
Organization Name:JAIME A. ABBOTT, DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:
Authorized Official - Last Name:ABBOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:810-639-6116
Mailing Address - Street 1:106 NANITA DR
Mailing Address - Street 2:PO BOX 3280
Mailing Address - City:MONTROSE
Mailing Address - State:MI
Mailing Address - Zip Code:48457-9164
Mailing Address - Country:US
Mailing Address - Phone:810-639-6116
Mailing Address - Fax:810-639-8010
Practice Address - Street 1:106 NANITA DR
Practice Address - Street 2:# 3280
Practice Address - City:MONTROSE
Practice Address - State:MI
Practice Address - Zip Code:48457-9164
Practice Address - Country:US
Practice Address - Phone:810-639-6116
Practice Address - Fax:810-639-8010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-26
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901018879122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty