Provider Demographics
NPI:1265648893
Name:JAMISON, DAVID LEE SR (DDS, PC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:LEE
Last Name:JAMISON
Suffix:SR
Gender:M
Credentials:DDS, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 CENTRE CT
Mailing Address - Street 2:
Mailing Address - City:LYNNFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01940-1715
Mailing Address - Country:US
Mailing Address - Phone:781-334-3400
Mailing Address - Fax:781-334-5201
Practice Address - Street 1:4 CENTRE CT
Practice Address - Street 2:
Practice Address - City:LYNNFIELD
Practice Address - State:MA
Practice Address - Zip Code:01940-1715
Practice Address - Country:US
Practice Address - Phone:781-334-3400
Practice Address - Fax:781-334-5201
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA126051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice