Healthcare Provider Details

I. General information

NPI: 1679646830
Provider Name (Legal Business Name): JIMMY D MCDOWELL DDS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 08/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 TEQUESTA DR SUITE 3F
TEQUESTA FL
33469-2733
US

IV. Provider business mailing address

175 TEQUESTA DR SUITE 3F
TEQUESTA FL
33469-2733
US

V. Phone/Fax

Practice location:
  • Phone: 561-746-0248
  • Fax: 561-746-5095
Mailing address:
  • Phone: 561-746-0248
  • Fax: 561-746-5095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN11646
License Number StateFL

VIII. Authorized Official

Name: DR. JIMMY D MCDOWELL
Title or Position: OWNER PRESIDENT
Credential: DDS
Phone: 561-746-0248