Healthcare Provider Details

I. General information

NPI: 1881766830
Provider Name (Legal Business Name): JAMES K VICK DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1222 JEFFERSON PARK AVE
CHARLOTTESVILLE VA
22903-3410
US

IV. Provider business mailing address

PO BOX 749112
ATLANTA GA
30374-9112
US

V. Phone/Fax

Practice location:
  • Phone: 434-924-1774
  • Fax: 434-243-6378
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0401415402
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code1223X2210X
TaxonomyOrofacial Pain Dentistry
License Number0401415402
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: