Provider Demographics
NPI:1679646830
Name:JIMMY D MCDOWELL DDS PA
Entity Type:Organization
Organization Name:JIMMY D MCDOWELL DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:D
Authorized Official - Last Name:MCDOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:561-746-0248
Mailing Address - Street 1:175 TEQUESTA DR
Mailing Address - Street 2:SUITE 3F
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:561-746-5095
Practice Address - Street 1:175 TEQUESTA DR
Practice Address - Street 2:SUITE 3F
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:561-746-5095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN116461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty