Provider Demographics
NPI:1639911365
Name:SOBCZAK, JAMIE ELIZABETH (DMD)
Entity type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:ELIZABETH
Last Name:SOBCZAK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 WOODRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:STREAMWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60107-1549
Mailing Address - Country:US
Mailing Address - Phone:319-316-2525
Mailing Address - Fax:
Practice Address - Street 1:530 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:DOWAGIAC
Practice Address - State:MI
Practice Address - Zip Code:49047-2101
Practice Address - Country:US
Practice Address - Phone:269-240-9688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-12
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901602143122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist