Healthcare Provider Details

I. General information

NPI: 1982865093
Provider Name (Legal Business Name): JAMERA DDS PC & ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2008
Last Update Date: 06/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4321 JAMES MADISON HWY SUITE 6
FORK UNION VA
23055-2025
US

IV. Provider business mailing address

4321 JAMES MADISON HWY SUITE 6
FORK UNION VA
23055-2025
US

V. Phone/Fax

Practice location:
  • Phone: 434-842-3504
  • Fax: 434-842-3534
Mailing address:
  • Phone: 434-842-3504
  • Fax: 434-842-3534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number401006912
License Number StateVA

VIII. Authorized Official

Name: MRS. DEBRA LYNN HOCKETT
Title or Position: OFFICE ADMINISTRATOR
Credential:
Phone: 804-379-9375