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General NPI Number Information
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NPI Number | 1033854740
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Entity Type | Organization
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Legal Business Name | JMJ PRACTICE HOLDINGS, LLC
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Dates
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Enumeration Date | 04/28/2022
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Last Update Date | 12/18/2025
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Provider Practice Location Address
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Address Line | 914 12TH AVE RD STE 102
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City | NAMPA
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State | ID
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Zip | 83686-5735
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Country | US
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Telephone | 208-996-3010
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Fax |
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Provider Business Mailing Address
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Address Line | 914 12TH AVE RD STE 102
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City | NAMPA
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State | ID
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Zip | 83686-5735
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Country | US
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Telephone | 208-996-3010
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF PAYOR RELATIONS
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Name | CASSANDRA WIETH
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Credential |
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Telephone | 623-267-8121
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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