Provider Demographics
NPI:1992910707
Name:JAMIESON, JEFFREY ALLAN (DDS, MS, CERT ORTHO)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:ALLAN
Last Name:JAMIESON
Suffix:
Gender:M
Credentials:DDS, MS, CERT ORTHO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1029 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-2679
Mailing Address - Country:US
Mailing Address - Phone:906-228-8720
Mailing Address - Fax:
Practice Address - Street 1:1029 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-2679
Practice Address - Country:US
Practice Address - Phone:906-228-8720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0196791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice