Provider Demographics
NPI:1780726406
Name:OBERMILLER, JAMA L (DDS)
Entity type:Individual
Prefix:DR
First Name:JAMA
Middle Name:L
Last Name:OBERMILLER
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 1:4112 BUCKINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-6426
Mailing Address - Country:US
Mailing Address - Phone:308-398-0208
Mailing Address - Fax:
Practice Address - Street 1:1003 W 3RD ST
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68801-5831
Practice Address - Country:US
Practice Address - Phone:308-382-0110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE6361122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist