MEDICARE: DR. JAMES NOEL HERNDON D.D.S.

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	4722	OK

General Provider Information

NPI Number	:	1932181195
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES NOEL HERNDON D.D.S.

Provider Business Mailing Address
First Line	:	425 W TRUMAN PL
Second Line	:
City	:	PURCELL
State	:	OK
Zip	:	73080-3209
Country	:	US
Telephone Number	:	405-527-7070
Fax Number	:	405-527-3046

Provider Business Practice Location Address
First Line	:	425 W TRUMAN PL
Second Line	:
City	:	PURCELL
State	:	OK
Zip	:	73080-3209
Country	:	US
Telephone Number	:	405-527-7070
Fax Number	:	405-527-3046

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

Provider Enumeration Date	:	11/15/2005
Last Update Date	:	07/09/2007

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