Provider Demographics
NPI:1043903842
Name:JAIME THONY PA
Entity type:Organization
Organization Name:JAIME THONY PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:
Authorized Official - Last Name:THONY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:850-459-5678
Mailing Address - Street 1:2770 ANDES WAY
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34769-5233
Mailing Address - Country:US
Mailing Address - Phone:850-459-5678
Mailing Address - Fax:
Practice Address - Street 1:1450 TUSKAWILLA RD STE 116
Practice Address - Street 2:
Practice Address - City:WINTER SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32708-5204
Practice Address - Country:US
Practice Address - Phone:850-459-5678
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-30
Last Update Date:2023-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental