Healthcare Provider Details

I. General information

NPI: 1376651281
Provider Name (Legal Business Name): JAMES E WAMPLER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 DEFENSE HWY
CROWNSVILLE MD
21032-2314
US

IV. Provider business mailing address

550 DEFENSE HWY
CROWNSVILLE MD
21032-2314
US

V. Phone/Fax

Practice location:
  • Phone: 410-721-1750
  • Fax: 410-841-1401
Mailing address:
  • Phone: 410-721-1750
  • Fax: 410-841-1401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number8283
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: