1659592426 NPI number — DR. JAMMIE KENT STRICKLIN DMD

Table of content: DR. JAMMIE KENT STRICKLIN DMD (NPI 1659592426)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659592426 NPI number — DR. JAMMIE KENT STRICKLIN DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STRICKLIN
Provider First Name:
JAMMIE
Provider Middle Name:
KENT
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659592426
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 SMALL STREET
Provider Second Line Business Mailing Address:
P.O. BOX 866
Provider Business Mailing Address City Name:
HARRISBURG
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62946
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-252-1725
Provider Business Mailing Address Fax Number:
618-252-5437

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 SMALL STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARRISBURG
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61946
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-252-1725
Provider Business Practice Location Address Fax Number:
618-252-5437
Provider Enumeration Date:
05/01/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)