Provider Demographics
NPI:1265710552
Name:AHL, JAMIE DITTY (DMD, MS)
Entity type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:DITTY
Last Name:AHL
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:MISS
Other - First Name:JAMIE
Other - Middle Name:
Other - Last Name:DITTY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:69 GAELIC CT
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:DE
Mailing Address - Zip Code:19962-2610
Mailing Address - Country:US
Mailing Address - Phone:302-383-1400
Mailing Address - Fax:
Practice Address - Street 1:1004 S STATE ST
Practice Address - Street 2:SUITE 3
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-6925
Practice Address - Country:US
Practice Address - Phone:215-300-3444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-03
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEG1-00012321223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics