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General NPI Number Information
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NPI Number | 1487958500
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Entity Type | Individual
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Provider Name | JAMES C.A. MACK DDS
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Gender | Male
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Dates
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Enumeration Date | 01/04/2011
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Last Update Date | 01/04/2011
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Provider Practice Location Address
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Address Line | 110 HIGHLAND AVENUE
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City | NEW STANTON
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State | PA
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Zip | 15672
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Country | US
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Telephone | 724-925-6010
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Fax | 724-925-8631
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Provider Business Mailing Address
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Address Line | 110 HIGHLAND AVENUE P.O. BOX 65
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City | NEW STANTON
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State | PA
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Zip | 15672
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Country | US
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Telephone | 724-925-6010
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Fax | 724-925-8631
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DS020328L
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License Number State | PA
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