MEDICARE: DR. JAMES E HEREFORD 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	1223G0001X	General Practice Dentistry	4112	OK

General Provider Information

NPI Number	:	1972587400
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES E HEREFORD DDS

Provider Business Mailing Address
First Line	:	1111 W MAIN ST
Second Line	:
City	:	COLLINSVILLE
State	:	OK
Zip	:	74021-3112
Country	:	US
Telephone Number	:	918-371-3375
Fax Number	:	918-371-4407

Provider Business Practice Location Address
First Line	:	1111 W MAIN ST
Second Line	:
City	:	COLLINSVILLE
State	:	OK
Zip	:	74021-3112
Country	:	US
Telephone Number	:	918-371-3375
Fax Number	:	918-371-4407

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

Provider Enumeration Date	:	11/29/2005
Last Update Date	:	04/21/2008

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