Provider Demographics
NPI:1366024770
Name:PINA, JAMIE (RDH)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:PINA
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:LYN
Other - Last Name:SAMMONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1200 N TEXAS ST
Mailing Address - Street 2:
Mailing Address - City:DERIDDER
Mailing Address - State:LA
Mailing Address - Zip Code:70634-2746
Mailing Address - Country:US
Mailing Address - Phone:623-521-3384
Mailing Address - Fax:
Practice Address - Street 1:2 E POINTE CT
Practice Address - Street 2:
Practice Address - City:ENTERPRISE
Practice Address - State:AL
Practice Address - Zip Code:36330-1392
Practice Address - Country:US
Practice Address - Phone:334-347-3061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-25
Last Update Date:2021-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL000026124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist