Provider Demographics
NPI:1639153034
Name:JAYME, ANNELEE (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANNELEE
Middle Name:
Last Name:JAYME
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:ANNIE
Other - Middle Name:THERESE
Other - Last Name:JAYME
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:PO BOX 1080
Mailing Address - Street 2:
Mailing Address - City:BURKESVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42717-1080
Mailing Address - Country:US
Mailing Address - Phone:270-858-6655
Mailing Address - Fax:270-858-4607
Practice Address - Street 1:360 KEEN ST
Practice Address - Street 2:
Practice Address - City:BURKESVILLE
Practice Address - State:KY
Practice Address - Zip Code:42717-7915
Practice Address - Country:US
Practice Address - Phone:844-435-0900
Practice Address - Fax:606-427-0858
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-30
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY74111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60000551Medicaid