Provider Demographics
NPI:1538398284
Name:GROSS, JAMIE J (DDS)
Entity type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:J
Last Name:GROSS
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 1:410 N WESTERN ST
Mailing Address - Street 2:
Mailing Address - City:SANBORN
Mailing Address - State:IA
Mailing Address - Zip Code:51248-1109
Mailing Address - Country:US
Mailing Address - Phone:712-930-5550
Mailing Address - Fax:712-930-5575
Practice Address - Street 1:410 N WESTERN ST
Practice Address - Street 2:
Practice Address - City:SANBORN
Practice Address - State:IA
Practice Address - Zip Code:51248-1109
Practice Address - Country:US
Practice Address - Phone:712-930-5550
Practice Address - Fax:712-930-5575
Is Sole Proprietor?:No
Enumeration Date:2009-07-02
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA086391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice