Healthcare Provider Details

I. General information

NPI: 1255390407
Provider Name (Legal Business Name): JAMES C IP DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 10/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1820 COLLEGE POINT BLVD
COLLEGE POINT NY
11356-2221
US

IV. Provider business mailing address

1820 COLLEGE POINT BLVD
COLLEGE POINT NY
11356-2221
US

V. Phone/Fax

Practice location:
  • Phone: 718-762-1199
  • Fax: 718-762-1199
Mailing address:
  • Phone: 718-762-1199
  • Fax: 718-762-1199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number030494
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: