Provider Demographics
NPI:1003973009
Name:JAMES, KEVIN MALCOLM (DMD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:MALCOLM
Last Name:JAMES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 CALHOUN ST
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:SC
Mailing Address - Zip Code:29108-3445
Mailing Address - Country:US
Mailing Address - Phone:803-276-0940
Mailing Address - Fax:803-276-0941
Practice Address - Street 1:1108 CALHOUN ST
Practice Address - Street 2:
Practice Address - City:NEWBERRY
Practice Address - State:SC
Practice Address - Zip Code:29108-3445
Practice Address - Country:US
Practice Address - Phone:803-276-0940
Practice Address - Fax:803-276-0941
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC41061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZX4106Medicaid