Healthcare Provider Details

I. General information

NPI: 1265710552
Provider Name (Legal Business Name): JAMIE DITTY AHL DMD, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS JAMIE DITTY

II. Dates (important events)

Enumeration Date: 08/03/2011
Last Update Date: 11/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1004 S STATE ST SUITE 3
DOVER DE
19901-6925
US

IV. Provider business mailing address

69 GAELIC CT
MAGNOLIA DE
19962-2610
US

V. Phone/Fax

Practice location:
  • Phone: 215-300-3444
  • Fax:
Mailing address:
  • Phone: 302-383-1400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberG1-0001232
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: