Provider Demographics
NPI:1316103161
Name:KNOX, JAMIE M (DDS)
Entity type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:M
Last Name:KNOX
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3893 CIBOLO VALLEY DR STE 104
Mailing Address - Street 2:
Mailing Address - City:SCHERTZ
Mailing Address - State:TX
Mailing Address - Zip Code:78108-3648
Mailing Address - Country:US
Mailing Address - Phone:210-658-7200
Mailing Address - Fax:
Practice Address - Street 1:3893 CIBOLO VALLEY DR STE 104
Practice Address - Street 2:
Practice Address - City:SCHERTZ
Practice Address - State:TX
Practice Address - Zip Code:78108-3648
Practice Address - Country:US
Practice Address - Phone:210-658-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-31
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24412122300000X, 1223G0001X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX24412OtherDENTIST