Healthcare Provider Details

I. General information

NPI: 1558499608
Provider Name (Legal Business Name): JAIME LYN STEELE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 12/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9602 E WASHINGTON ST SUITE C
INDIANAPOLIS IN
46229-4504
US

IV. Provider business mailing address

415 N GRAND AVE
PUEBLO CO
81003-3111
US

V. Phone/Fax

Practice location:
  • Phone: 317-899-5437
  • Fax:
Mailing address:
  • Phone: 719-583-1800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12010792A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number12010792A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: