Provider Demographics
NPI:1083638134
Name:BEHM, JAMES C (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:C
Last Name:BEHM
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 1:1917 E MILWAUKEE ST
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53545-2647
Mailing Address - Country:US
Mailing Address - Phone:608-754-2554
Mailing Address - Fax:608-754-3535
Practice Address - Street 1:1917 E MILWAUKEE ST
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53545-2647
Practice Address - Country:US
Practice Address - Phone:608-754-2554
Practice Address - Fax:608-754-3535
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI003067122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33447900Medicaid