Provider Demographics
NPI:1851085344
Name:JAMIE DIMOND DDS, PLLC
Entity Type:Organization
Organization Name:JAMIE DIMOND DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DIMOND
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:501-412-1056
Mailing Address - Street 1:928 S 27TH ST
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-4826
Mailing Address - Country:US
Mailing Address - Phone:501-412-1056
Mailing Address - Fax:
Practice Address - Street 1:615 W OAK ST
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756-5315
Practice Address - Country:US
Practice Address - Phone:479-391-3291
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental