Provider Demographics
NPI:1558565606
Name:MATT T JAM DDS INC
Entity Type:Organization
Organization Name:MATT T JAM DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATT
Authorized Official - Middle Name:TEIMOURI
Authorized Official - Last Name:JAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:670-347-7505
Mailing Address - Street 1:81730 HWY 111 SUITE 8
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201
Mailing Address - Country:US
Mailing Address - Phone:760-347-7505
Mailing Address - Fax:760-347-6425
Practice Address - Street 1:81730 HWY 111 SUITE 8
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201
Practice Address - Country:US
Practice Address - Phone:760-347-7505
Practice Address - Fax:760-347-6425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental