Provider Demographics
NPI:1013181593
Name:BOUNDS, JAMES A (DMD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:A
Last Name:BOUNDS
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 1:1010 N 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MS
Mailing Address - Zip Code:39440-2656
Mailing Address - Country:US
Mailing Address - Phone:601-649-3511
Mailing Address - Fax:
Practice Address - Street 1:1010 N 15TH AVE
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MS
Practice Address - Zip Code:39440-2656
Practice Address - Country:US
Practice Address - Phone:601-649-3511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-16
Last Update Date:2022-01-05
Deactivation Date:2021-12-08
Deactivation Code:
Reactivation Date:2022-01-05
Provider Licenses
StateLicense IDTaxonomies
MS200483122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00660241Medicaid