Provider Demographics
NPI:1740334887
Name:ABBOTT, JAIME ANNE NOWICKI (DDS)
Entity type:Individual
Prefix:DR
First Name:JAIME
Middle Name:ANNE NOWICKI
Last Name:ABBOTT
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:PO BOX 3280
Mailing Address - Street 2:106 NANITA DR
Mailing Address - City:MONTROSE
Mailing Address - State:MI
Mailing Address - Zip Code:48457
Mailing Address - Country:US
Mailing Address - Phone:810-639-6116
Mailing Address - Fax:810-639-8010
Practice Address - Street 1:106 NANITA DR
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:MI
Practice Address - Zip Code:48457
Practice Address - Country:US
Practice Address - Phone:810-639-6116
Practice Address - Fax:810-639-6116
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901018879122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist