Provider Demographics
NPI:1194278812
Name:GREENWELL, JAMIE LYNN (DMD, MS, ABGD, FAGD)
Entity type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:LYNN
Last Name:GREENWELL
Suffix:
Gender:F
Credentials:DMD, MS, ABGD, FAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7120 S-231
Mailing Address - Street 2:
Mailing Address - City:HUNTINGBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47542
Mailing Address - Country:US
Mailing Address - Phone:440-590-5350
Mailing Address - Fax:
Practice Address - Street 1:7120 S US HIGHWAY 231
Practice Address - Street 2:
Practice Address - City:HUNTINGBURG
Practice Address - State:IN
Practice Address - Zip Code:47542-9319
Practice Address - Country:US
Practice Address - Phone:812-683-2431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-28
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12013971A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice