Organization
AMAZING DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RUTHIE M JIMERSON DDS (PRESIDENT)
(812) 488-2008
Entity
Organization
Contact information
Practice address
5200 WASHINGTON AVE, SUITE E, EVANSVILLE, IN 47715-4863
(812) 488-2008
(812) 475-9831
Mailing address
5200 WASHINGTON AVE, SUITE E, EVANSVILLE, IN 47715-4863
(812) 488-2008
(812) 475-9831
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
12011105A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
IN
Enumeration date
05/13/2010
Last updated
05/13/2010
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