Provider Demographics
NPI:1083626741
Name:PREWITT, JAMES ROBINSON (DDS)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:ROBINSON
Last Name:PREWITT
Suffix:
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:PO BOX 53662
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28305-3662
Mailing Address - Country:US
Mailing Address - Phone:910-484-7878
Mailing Address - Fax:910-484-0505
Practice Address - Street 1:203 FAIRWAY DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305-5511
Practice Address - Country:US
Practice Address - Phone:910-484-7878
Practice Address - Fax:910-484-0505
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC50441223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCUC 818846OtherUNITED CONCORDIA