Provider Demographics
NPI:1073676722
Name:JAMES B. LICHTSINN, D.D.S., P.A.
Entity Type:Organization
Organization Name:JAMES B. LICHTSINN, D.D.S., P.A.
Other - Org Name:SOUTHPOINTE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:LICHTSINN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-280-1941
Mailing Address - Street 1:3210 18TH ST S STE A
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-6789
Mailing Address - Country:US
Mailing Address - Phone:701-280-1941
Mailing Address - Fax:
Practice Address - Street 1:3210 18TH ST S STE A
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-6789
Practice Address - Country:US
Practice Address - Phone:701-280-1941
Practice Address - Fax:701-364-1943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-17
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty