=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447518154
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR JAMES D. WINDELL, DMD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/01/2012
-----------------------------------------------------
Last Update Date | 05/01/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 135 NW 15TH ST
-----------------------------------------------------
City | NEWPORT
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97365-2348
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-265-2261
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 135 NW 15TH ST
-----------------------------------------------------
City | NEWPORT
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97365-2348
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-265-2261
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | ANDREA JONES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 541-265-2261
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number | 5137
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------