Provider Demographics
NPI:1194002592
Name:JAMBOREE DENTISTRY PLLC
Entity Type:Organization
Organization Name:JAMBOREE DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:THEODORE
Authorized Official - Last Name:SPIGER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:713-644-3000
Mailing Address - Street 1:6336 TELEPHONE RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77087-5410
Mailing Address - Country:US
Mailing Address - Phone:713-644-3000
Mailing Address - Fax:713-644-3004
Practice Address - Street 1:6336 TELEPHONE RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77087-5410
Practice Address - Country:US
Practice Address - Phone:713-644-3000
Practice Address - Fax:713-644-3004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-14
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24116122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty