=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518971704
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMES TAYLOR CIRGIN DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/27/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 51 N MAIN ST
-----------------------------------------------------
City | SPENCER
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47460-1311
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-829-2261
-----------------------------------------------------
Fax | 812-829-2263
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 51 N MAIN ST
-----------------------------------------------------
City | SPENCER
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47460-1311
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-829-2261
-----------------------------------------------------
Fax | 812-829-2263
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 7115
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------