Provider Demographics
NPI:1740631977
Name:HOUCK, JAMIE MELLERT (DDS)
Entity type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:MELLERT
Last Name:HOUCK
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 1:3480 TORRANCE BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-5808
Mailing Address - Country:US
Mailing Address - Phone:310-543-1234
Mailing Address - Fax:310-543-8795
Practice Address - Street 1:3480 TORRANCE BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-5808
Practice Address - Country:US
Practice Address - Phone:310-543-1234
Practice Address - Fax:310-543-8795
Is Sole Proprietor?:No
Enumeration Date:2016-06-29
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100290122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice