Provider Demographics
NPI:1033125323
Name:DYER, JAMES ANTHONY (DMD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ANTHONY
Last Name:DYER
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:P.O. BOX 474
Mailing Address - Street 2:131 BOSTON POST ROAD
Mailing Address - City:EAST LYME
Mailing Address - State:CT
Mailing Address - Zip Code:06333
Mailing Address - Country:US
Mailing Address - Phone:860-739-4901
Mailing Address - Fax:
Practice Address - Street 1:131 BOSTON POST ROAD
Practice Address - Street 2:
Practice Address - City:EAST LYME
Practice Address - State:CT
Practice Address - Zip Code:06333
Practice Address - Country:US
Practice Address - Phone:860-739-4901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT46201223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT4620OtherCT DENTAL LICENSE
AD1920190OtherDEA #
CT4620OtherCT DENTAL LICENSE
T22643Medicare UPIN