Healthcare Provider Details

I. General information

NPI: 1548905250
Provider Name (Legal Business Name): JMJ HOLDING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2022
Last Update Date: 04/28/2022
Certification Date: 04/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

914 12TH AVE RD STE 102
NAMPA ID
83686-5735
US

IV. Provider business mailing address

914 12TH AVE RD STE 102
NAMPA ID
83686-5735
US

V. Phone/Fax

Practice location:
  • Phone: 208-996-3010
  • Fax:
Mailing address:
  • Phone: 208-996-3010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: JESSICA SPINKS
Title or Position: REVENUE OPTIMIZATION ANALYST
Credential:
Phone: 541-508-5946