Individual
JACALYN RENEE DAMES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4092 CREST DR, HOUSE SPRINGS, MO 63051-1570
(636) 575-8436
Mailing address
4092 CREST DR, HOUSE SPRINGS, MO 63051-1570
(636) 575-8436
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
X183076005
MO
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
X183076005
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
37424356
—
MO
Enumeration date
07/16/2014
Last updated
07/16/2014
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