Provider Demographics
NPI:1457484479
Name:BELKNAP, JAMIE
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:
Last Name:BELKNAP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 24TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-5110
Mailing Address - Country:US
Mailing Address - Phone:405-329-6603
Mailing Address - Fax:405-447-8333
Practice Address - Street 1:420 24TH AVE SW
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-5110
Practice Address - Country:US
Practice Address - Phone:405-329-6603
Practice Address - Fax:405-447-8333
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK48271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice