Provider Demographics
NPI:1275737983
Name:CARSTAIRS, JAMIE ROY (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:ROY
Last Name:CARSTAIRS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44025 JEFFERSON ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92253-4874
Mailing Address - Country:US
Mailing Address - Phone:760-989-4340
Mailing Address - Fax:
Practice Address - Street 1:44025 JEFFERSON ST
Practice Address - Street 2:SUITE 105
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-4874
Practice Address - Country:US
Practice Address - Phone:760-989-4340
Practice Address - Fax:760-262-3981
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA535801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice