Provider Demographics
NPI:1255998555
Name:COVINGTON, JAMIE NICOLE (DDS)
Entity type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:NICOLE
Last Name:COVINGTON
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 1:11751 S ARTESIAN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60655-1515
Mailing Address - Country:US
Mailing Address - Phone:773-946-2672
Mailing Address - Fax:
Practice Address - Street 1:7537 N CLARK ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60626-1621
Practice Address - Country:US
Practice Address - Phone:773-442-1272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-22
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3190216631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice