Provider Demographics
NPI:1467714873
Name:MCDOWELL, JIMMY DODSON (DDS)
Entity Type:Individual
Prefix:DR
First Name:JIMMY
Middle Name:DODSON
Last Name:MCDOWELL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 TEQUESTA DR STE 3F
Mailing Address - Street 2:
Mailing Address - City:TEQUESTA
Mailing Address - State:FL
Mailing Address - Zip Code:33469-2733
Mailing Address - Country:US
Mailing Address - Phone:561-746-0248
Mailing Address - Fax:
Practice Address - Street 1:175 TEQUESTA DR STE 3F
Practice Address - Street 2:
Practice Address - City:TEQUESTA
Practice Address - State:FL
Practice Address - Zip Code:33469-2733
Practice Address - Country:US
Practice Address - Phone:561-746-0248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN11646122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist