Provider Demographics
NPI:1144503715
Name:SPAULDING, JAIME LYN (DDS)
Entity type:Individual
Prefix:DR
First Name:JAIME
Middle Name:LYN
Last Name:SPAULDING
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MS
Other - First Name:JAIME
Other - Middle Name:LYN
Other - Last Name:KLEBIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3066 SHADYSIDE DR
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:WI
Mailing Address - Zip Code:53589-3244
Mailing Address - Country:US
Mailing Address - Phone:715-456-5148
Mailing Address - Fax:
Practice Address - Street 1:3066 SHADYSIDE DR
Practice Address - Street 2:
Practice Address - City:STOUGHTON
Practice Address - State:WI
Practice Address - Zip Code:53589-3244
Practice Address - Country:US
Practice Address - Phone:715-456-5148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6772-0151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice