Healthcare Provider Details

I. General information

NPI: 1356415830
Provider Name (Legal Business Name): JAMES M BRITTAIN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2711 RANDOLPH RD STE 201
CHARLOTTE NC
28207-2034
US

IV. Provider business mailing address

2711 RANDOLPH RD STE 201
CHARLOTTE NC
28207-2034
US

V. Phone/Fax

Practice location:
  • Phone: 704-372-0432
  • Fax: 704-372-2869
Mailing address:
  • Phone: 704-372-0432
  • Fax: 704-372-2869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number3532
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: