=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205931110
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JAMES M BRITTAIN DMD MS PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/14/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2711 RANDOLPH RD SUITE 201
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28207-2027
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-372-0432
-----------------------------------------------------
Fax | 704-372-2869
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2711 RANDOLPH RD SUITE 201
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28207-2027
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-372-0432
-----------------------------------------------------
Fax | 704-372-2869
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. JAMES M BRITTAIN
-----------------------------------------------------
Credential | DMD MS
-----------------------------------------------------
Telephone | 704-372-0432
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 3532
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------