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NPI Code Detail

MEDICARE: DR. JAMES EDWARD PHELAN DMD

MEDICARE: DR. JAMES EDWARD PHELAN DMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry13538MA

General Provider Information

NPI Number : 1093871832
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JAMES EDWARD PHELAN DMD
Provider Business Mailing Address
First Line : 1105 LAKEVIEW AVE
Second Line :
City : DRACUT
State : MA
Zip : 01825-4762
Country : US
Telephone Number : 978-957-0530
Fax Number : 978-957-0631
Provider Business Practice Location Address
First Line : 1105 LAKEVIEW AVE
Second Line :
City : DRACUT
State : MA
Zip : 01825-4762
Country : US
Telephone Number : 978-957-0530
Fax Number : 978-957-0631
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/28/2006
Last Update Date : 07/08/2007

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Directions to “ DR. JAMES EDWARD PHELAN DMD” Practice Location

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