Individual
DR. JAKE RYAN MIMMS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
8263 MADISON BLVD STE A, MADISON, AL 35758-2051
(256) 774-7228
Mailing address
8263 MADISON BLVD STE A, MADISON, AL 35758-2051
(256) 774-7228
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6432
AL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/28/2017
Last updated
07/17/2019
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