Provider Demographics
NPI:1285722645
Name:LA VIOLA, JAMIE JOHN (DMD)
Entity type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:JOHN
Last Name:LA VIOLA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 JOHN F KENNEDY DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:ATLANTIS
Mailing Address - State:FL
Mailing Address - Zip Code:33462-1119
Mailing Address - Country:US
Mailing Address - Phone:561-967-3513
Mailing Address - Fax:561-967-4705
Practice Address - Street 1:115 JOHN F KENNEDY DR
Practice Address - Street 2:SUITE B
Practice Address - City:ATLANTIS
Practice Address - State:FL
Practice Address - Zip Code:33462-1119
Practice Address - Country:US
Practice Address - Phone:561-967-3513
Practice Address - Fax:561-967-4705
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 17138122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist