Provider Demographics
NPI:1033392337
Name:ANDERSON, JAMES HAROLD (DMD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:HAROLD
Last Name:ANDERSON
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 1:975 REDDOCH COVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-3614
Mailing Address - Country:US
Mailing Address - Phone:901-682-2491
Mailing Address - Fax:901-682-5307
Practice Address - Street 1:975 REDDOCH COVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-3614
Practice Address - Country:US
Practice Address - Phone:901-682-2491
Practice Address - Fax:901-682-5307
Is Sole Proprietor?:No
Enumeration Date:2007-12-10
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS0000007571122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist