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General NPI Number Information
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NPI Number | 1487206561
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Entity Type | Individual
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Provider Name | JAIME CHRISTIAN THONY DDS
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Gender | Male
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Dates
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Enumeration Date | 07/10/2019
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Last Update Date | 12/24/2019
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Provider Practice Location Address
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Address Line | 1805 LAKELAND HILLS BLVD
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City | LAKELAND
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State | FL
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Zip | 33805-3062
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Country | US
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Telephone | 863-682-1500
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Fax |
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Provider Business Mailing Address
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Address Line | 196 MASON DR
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City | TITUSVILLE
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State | FL
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Zip | 32780-9115
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Country | US
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Telephone | 850-459-5678
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 24346
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License Number State | FL
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