Provider Demographics
NPI:1467672527
Name:PLANTZ, JAMISON LEE (DMD)
Entity Type:Individual
Prefix:DR
First Name:JAMISON
Middle Name:LEE
Last Name:PLANTZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 HARBOR BLVD
Mailing Address - Street 2:
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541
Mailing Address - Country:US
Mailing Address - Phone:850-837-6824
Mailing Address - Fax:850-837-8867
Practice Address - Street 1:305 HARBOR BLVD
Practice Address - Street 2:
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541
Practice Address - Country:US
Practice Address - Phone:850-837-6824
Practice Address - Fax:850-837-8867
Is Sole Proprietor?:No
Enumeration Date:2007-04-30
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFLDN14645122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist