Provider Demographics
NPI:1316323769
Name:ACORN, JAMISA
Entity type:Individual
Prefix:DR
First Name:JAMISA
Middle Name:
Last Name:ACORN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9370 W SAM HOUSTON PKWY S
Mailing Address - Street 2:UNIT F
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77099-5224
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9370 W SAM HOUSTON PKWY S
Practice Address - Street 2:UNIT F
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77099-5224
Practice Address - Country:US
Practice Address - Phone:712-692-6468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-08
Last Update Date:2015-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30344122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist