MEDICARE: DR. JAMES C IP DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	030494	NY

General Provider Information

NPI Number	:	1255390407
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES C IP DDS

Provider Business Mailing Address
First Line	:	1820 COLLEGE POINT BLVD
Second Line	:
City	:	COLLEGE POINT
State	:	NY
Zip	:	11356-2221
Country	:	US
Telephone Number	:	718-762-1199
Fax Number	:	718-762-1199

Provider Business Practice Location Address
First Line	:	1820 COLLEGE POINT BLVD
Second Line	:
City	:	COLLEGE POINT
State	:	NY
Zip	:	11356-2221
Country	:	US
Telephone Number	:	718-762-1199
Fax Number	:	718-762-1199

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/17/2006
Last Update Date	:	10/15/2016

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