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General NPI Number Information
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NPI Number | 1144897885
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Entity Type | Individual
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Provider Name | DYLAN EDWARD JAMES DDS
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Gender | Male
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Dates
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Enumeration Date | 06/10/2021
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Last Update Date | 03/12/2023
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Provider Practice Location Address
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Address Line | 2855 CAROLINA CHERRY DR
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City | SUAMICO
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State | WI
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Zip | 54313-3269
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Country | US
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Telephone | 920-499-8888
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Fax |
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Provider Business Mailing Address
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Address Line | 4955 FOUNDERS TER APT 308
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City | HOBART
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State | WI
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Zip | 54155-7714
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Country | US
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Telephone | 319-480-7260
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2021021360
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DS043426
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 6001133-15
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License Number State | WI
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