MEDICARE: DR. JAMES R SHADLE JR. D.D.S.

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
1	122300000X	Dentist	9948	TX

General Provider Information

NPI Number	:	1114920667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES R SHADLE JR. D.D.S.

Provider Business Mailing Address
First Line	:	907 MEDICAL CENTRE DR
Second Line	:	STE A
City	:	ARLINGTON
State	:	TX
Zip	:	76012-4756
Country	:	US
Telephone Number	:	817-543-0201
Fax Number	:

Provider Business Practice Location Address
First Line	:	907 MEDICAL CENTRE DR
Second Line	:	STE A
City	:	ARLINGTON
State	:	TX
Zip	:	76012-4756
Country	:	US
Telephone Number	:	817-543-0201
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/28/2005
Last Update Date	:	07/08/2007

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