Provider Demographics
NPI:1407584188
Name:JAMINE IFEDI, DDS, PLLC
Entity Type:Organization
Organization Name:JAMINE IFEDI, DDS, PLLC
Other - Org Name:EMPIRE DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMINE
Authorized Official - Middle Name:
Authorized Official - Last Name:IFEDI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:704-301-8398
Mailing Address - Street 1:1408 ORCHARD LAKE DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28270-1474
Mailing Address - Country:US
Mailing Address - Phone:704-301-8398
Mailing Address - Fax:
Practice Address - Street 1:1408 ORCHARD LAKE DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28270-1474
Practice Address - Country:US
Practice Address - Phone:704-301-8398
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-10
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty