Provider Demographics
NPI:1073673083
Name:DRYDEN, JAMES A (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:A
Last Name:DRYDEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
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Mailing Address - Street 1:PO BOX 1034
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72702-1034
Mailing Address - Country:US
Mailing Address - Phone:417-781-5151
Mailing Address - Fax:417-781-5890
Practice Address - Street 1:620 W 32ND ST
Practice Address - Street 2:SUITE A
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-2526
Practice Address - Country:US
Practice Address - Phone:417-621-0500
Practice Address - Fax:417-781-5809
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO107611223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
660586OtherUNITED CONCORDIA NONPAR
1700470971OtherCONNECTION DENTAL NETWORK
460264OtherBCBS DENTAL NON-PAR
10761OtherDELTA DENTAL
10761OtherCIGNA DENTAL PAR