Active NPI
Jamie Lee Childers, DMD
- General Practice Dentistry
- Muncie, IN
National Provider Identifier
1023780566
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 12013704A
- Practice address
- 1003 W McGalliard Rd
Muncie, IN 47303-1788 - Phone
- (765) 288-1307
- NPI assigned
- Oct 4, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 12013704A | IN | Primary |
Addresses
Primary practice location
1003 W McGalliard Rd
Muncie, IN 47303-1788
Mailing address
10900 E Jackson St
Selma, IN 47383-9451
Phone (765) 256-0940
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12013704A | IN | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1633305600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1633305600000",
"number": "1023780566",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10900 E JACKSON ST",
"city": "SELMA",
"state": "IN",
"postal_code": "473839451",
"telephone_number": "765-256-0940"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1003 W MCGALLIARD RD",
"city": "MUNCIE",
"state": "IN",
"postal_code": "473031788",
"telephone_number": "765-288-1307"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHILDERS",
"first_name": "JAMIE",
"middle_name": "LEE",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-10-04",
"last_updated": "2021-10-04",
"certification_date": "2021-10-04",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "IN",
"license": "12013704A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Muncie, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.