Healthcare Provider Details

I. General information

NPI: 1144203761
Provider Name (Legal Business Name): JAMES ROLAND OXFORD D.D.S., M.S.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 6TH ST
GREAT LAKES IL
60088-2833
US

IV. Provider business mailing address

3001 6TH ST
GREAT LAKES IL
60088-2833
US

V. Phone/Fax

Practice location:
  • Phone: 847-688-2616
  • Fax: 847-688-2382
Mailing address:
  • Phone: 847-688-2616
  • Fax: 847-688-2382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12008717A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: