MEDICARE: MR. JAMES A GAINER DDS

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	8564	MD
2	122300000X	Dentist	9067	NC

General Provider Information

NPI Number	:	1174576516
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES A GAINER DDS

Provider Business Mailing Address
First Line	:	3725 WRIGHTSVILLE AVE
Second Line	:	STE A
City	:	WILMINGTON
State	:	NC
Zip	:	28403-4041
Country	:	US
Telephone Number	:	910-799-9699
Fax Number	:	910-792-9987

Provider Business Practice Location Address
First Line	:	3725 WRIGHTSVILLE AVE
Second Line	:	STE A
City	:	WILMINGTON
State	:	NC
Zip	:	28403-4041
Country	:	US
Telephone Number	:	910-799-9699
Fax Number	:	910-792-9987

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

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	05/02/2011

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