Provider Demographics
NPI:1487206561
Name:THONY, JAIME CHRISTIAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAIME
Middle Name:CHRISTIAN
Last Name:THONY
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 1:196 MASON DR
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32780-9115
Mailing Address - Country:US
Mailing Address - Phone:850-459-5678
Mailing Address - Fax:
Practice Address - Street 1:1805 LAKELAND HILLS BLVD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-3062
Practice Address - Country:US
Practice Address - Phone:863-682-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-10
Last Update Date:2019-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24346122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist