Provider Demographics
NPI:1285020966
Name:SEDATION IMPLANT DENTISTRY PL
Entity Type:Organization
Organization Name:SEDATION IMPLANT DENTISTRY PL
Other - Org Name:OCALA PERIODONTICS & DENTAL IMPLANTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:N
Authorized Official - Last Name:AMIR
Authorized Official - Suffix:
Authorized Official - Credentials:BDS, MS
Authorized Official - Phone:352-219-4430
Mailing Address - Street 1:1809 SE 32ND LN
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-6746
Mailing Address - Country:US
Mailing Address - Phone:352-219-4430
Mailing Address - Fax:
Practice Address - Street 1:4600 SW 46TH CT
Practice Address - Street 2:BUILDING 200, SUITE 360
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-5708
Practice Address - Country:US
Practice Address - Phone:352-350-1599
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-09
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN179581223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty