Provider Demographics
NPI:1174658033
Name:MAHER, JAMIE E (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:E
Last Name:MAHER
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 1:401 E SIOUX AVE
Mailing Address - Street 2:
Mailing Address - City:PIERRE
Mailing Address - State:SD
Mailing Address - Zip Code:57501-3162
Mailing Address - Country:US
Mailing Address - Phone:605-224-8858
Mailing Address - Fax:605-224-8859
Practice Address - Street 1:401 E SIOUX AVE
Practice Address - Street 2:
Practice Address - City:PIERRE
Practice Address - State:SD
Practice Address - Zip Code:57501-3162
Practice Address - Country:US
Practice Address - Phone:605-224-8858
Practice Address - Fax:605-224-8859
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDM994122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD7809990Medicaid
SDM994OtherSD LICENSE NUMBER