Healthcare Provider Details

I. General information

NPI: 1528063625
Provider Name (Legal Business Name): JAMES M. MCCALL D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date: 03/18/2006
Reactivation Date: 03/29/2006

III. Provider practice location address

603 NICHOLS ST
FULTON MO
65251-2650
US

IV. Provider business mailing address

603 NICHOLS ST
FULTON MO
65251-2650
US

V. Phone/Fax

Practice location:
  • Phone: 573-642-6904
  • Fax: 573-642-7256
Mailing address:
  • Phone: 573-642-6904
  • Fax: 573-642-7256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number11961
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: