Provider Demographics
NPI:1083601686
Name:WIMSATT, JAMES A III (DDS)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:A
Last Name:WIMSATT
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13231 FULLENWIDER CIR
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-6709
Mailing Address - Country:US
Mailing Address - Phone:907-580-5202
Mailing Address - Fax:907-580-5022
Practice Address - Street 1:5955 ZEAMER AVE
Practice Address - Street 2:
Practice Address - City:ELMENDORF AFB
Practice Address - State:AK
Practice Address - Zip Code:99506-3702
Practice Address - Country:US
Practice Address - Phone:907-580-5202
Practice Address - Fax:907-580-5022
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK49001223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery