Provider Demographics
NPI:1720579071
Name:GAINOUS, JAZZIME D (DENTAL HYGIENST)
Entity Type:Individual
Prefix:
First Name:JAZZIME
Middle Name:D
Last Name:GAINOUS
Suffix:
Gender:F
Credentials:DENTAL HYGIENST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:438 W BREVARD ST
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32301-1004
Mailing Address - Country:US
Mailing Address - Phone:850-606-8226
Mailing Address - Fax:
Practice Address - Street 1:3013 JIM LEE RD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-7057
Practice Address - Country:US
Practice Address - Phone:850-414-5560
Practice Address - Fax:850-414-5561
Is Sole Proprietor?:No
Enumeration Date:2018-05-22
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDH25318124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist