Provider Demographics
NPI:1497984686
Name:CARLILE, JAMIE (DDS)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:CARLILE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:
Other - Last Name:MARR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2212 BLUFFTON DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-7439
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5501 INDEPENDENCE PKWY
Practice Address - Street 2:ST. 200
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75023-5463
Practice Address - Country:US
Practice Address - Phone:972-867-8882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-08
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX247391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice