Provider Demographics
NPI:1104237775
Name:JAMBOREE DENTISTRY AND ORTHODONTICS
Entity type:Organization
Organization Name:JAMBOREE DENTISTRY AND ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:SPIGER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:713-644-3000
Mailing Address - Street 1:4400 NORTH FWY
Mailing Address - Street 2:SPACE D500
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77022-3604
Mailing Address - Country:US
Mailing Address - Phone:713-644-3000
Mailing Address - Fax:
Practice Address - Street 1:4400 NORTH FWY
Practice Address - Street 2:SPACE D500
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77022-3604
Practice Address - Country:US
Practice Address - Phone:713-644-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-16
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24116122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty