Provider Demographics
NPI:1053535534
Name:AMES, JODY WILLIAM (DDS)
Entity type:Individual
Prefix:DR
First Name:JODY
Middle Name:WILLIAM
Last Name:AMES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 W LOCUST ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:WILMINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:45177-2572
Mailing Address - Country:US
Mailing Address - Phone:937-382-6971
Mailing Address - Fax:
Practice Address - Street 1:1195 W 2ND ST
Practice Address - Street 2:
Practice Address - City:XENIA
Practice Address - State:OH
Practice Address - Zip Code:45385-3702
Practice Address - Country:US
Practice Address - Phone:937-372-8502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30020527122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist