Healthcare Provider Details

I. General information

NPI: 1689513566
Provider Name (Legal Business Name): JAMES MARTIN WAITE DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 N FORT THOMAS AVE
FORT THOMAS KY
41075-1518
US

IV. Provider business mailing address

103 N FORT THOMAS AVE
FORT THOMAS KY
41075-1518
US

V. Phone/Fax

Practice location:
  • Phone: 859-360-2118
  • Fax:
Mailing address:
  • Phone: 859-360-2118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number5982
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: