Provider Demographics
NPI:1437507761
Name:JAMESEN ORTHODONTICS
Entity Type:Organization
Organization Name:JAMESEN ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:S
Authorized Official - Last Name:JAMESEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:214-392-0500
Mailing Address - Street 1:8600 PRECINCT LINE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-7685
Mailing Address - Country:US
Mailing Address - Phone:214-392-0500
Mailing Address - Fax:
Practice Address - Street 1:8600 PRECINCT LINE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-7685
Practice Address - Country:US
Practice Address - Phone:214-392-0500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-26
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX234991223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty