MEDICARE: DR. JAMES M. RANSDELL 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	1223G0001X	General Practice Dentistry	D6757	AZ

General Provider Information

NPI Number	:	1356386676
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES M. RANSDELL DDS

Provider Business Mailing Address
First Line	:	2750 W WIGWAM AVE
Second Line	:	APT# 1207
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-6643
Country	:	US
Telephone Number	:	702-366-3797
Fax Number	:	928-718-2106

Provider Business Practice Location Address
First Line	:	1751 N STOCKTON HILL RD
Second Line	:	STE# A
City	:	KINGMAN
State	:	AZ
Zip	:	86401-6601
Country	:	US
Telephone Number	:	928-718-8668
Fax Number	:	928-718-2106

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

Provider Enumeration Date	:	06/19/2006
Last Update Date	:	07/08/2007

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