Provider Demographics
NPI:1760487045
Name:CHILDRESS, JAMIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:
Last Name:CHILDRESS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 CHELSEA DR
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:VA
Mailing Address - Zip Code:20186-2841
Mailing Address - Country:US
Mailing Address - Phone:540-349-7159
Mailing Address - Fax:
Practice Address - Street 1:13601 OFFICE PL
Practice Address - Street 2:SUITE 202
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-4213
Practice Address - Country:US
Practice Address - Phone:703-670-7071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014110271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice