=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821310319
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OPELIKA DENTAL ARTS, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/24/2010
-----------------------------------------------------
Last Update Date | 02/24/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1957 1ST AVE
-----------------------------------------------------
City | OPELIKA
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36801-5403
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-745-3135
-----------------------------------------------------
Fax | 334-749-3120
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1957 1ST AVE
-----------------------------------------------------
City | OPELIKA
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36801-5403
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-745-3135
-----------------------------------------------------
Fax | 334-749-3120
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST
-----------------------------------------------------
Name | DR. JAMES ANDREW TATUM
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 334-745-3135
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 4263
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------