Provider Demographics
NPI:1053353912
Name:CROSSMAN, JAMIE MARIE (DDS)
Entity type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:MARIE
Last Name:CROSSMAN
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 1:299 FAIRGROUNDS RD
Mailing Address - Street 2:SUITE #2
Mailing Address - City:HAMILTON
Mailing Address - State:MT
Mailing Address - Zip Code:59840-3199
Mailing Address - Country:US
Mailing Address - Phone:406-363-1911
Mailing Address - Fax:406-363-3022
Practice Address - Street 1:299 FAIRGROUNDS RD
Practice Address - Street 2:SUITE #2
Practice Address - City:HAMILTON
Practice Address - State:MT
Practice Address - Zip Code:59840-3199
Practice Address - Country:US
Practice Address - Phone:406-363-1911
Practice Address - Fax:406-363-3022
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT18411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT5512338OtherBLUE CHIP
MT0130208Medicaid