Provider Demographics
NPI:1285846303
Name:MANDERS, JAMIE MARIA (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:MARIA
Last Name:MANDERS
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 1:13201 RIVER ROAD
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70131-3208
Mailing Address - Country:US
Mailing Address - Phone:504-394-7702
Mailing Address - Fax:
Practice Address - Street 1:13201 RIVER ROAD
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70131-3208
Practice Address - Country:US
Practice Address - Phone:504-394-7702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA33051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice