Healthcare Provider Details

I. General information

NPI: 1649280710
Provider Name (Legal Business Name): JAMES ANDREW MACROBERT DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 E JEFFERSON ST
MANGUM OK
73554-4202
US

IV. Provider business mailing address

110 W HARRISON ST
MANGUM OK
73554-3002
US

V. Phone/Fax

Practice location:
  • Phone: 580-782-2552
  • Fax: 580-782-9266
Mailing address:
  • Phone: 580-782-2552
  • Fax: 580-782-9266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2808
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: