Provider Demographics
NPI:1114920667
Name:SHADLE, JAMES R JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:R
Last Name:SHADLE
Suffix:JR
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 1:907 MEDICAL CENTRE DR
Mailing Address - Street 2:STE A
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012-4756
Mailing Address - Country:US
Mailing Address - Phone:817-543-0201
Mailing Address - Fax:
Practice Address - Street 1:907 MEDICAL CENTRE DR
Practice Address - Street 2:STE A
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-4756
Practice Address - Country:US
Practice Address - Phone:817-543-0201
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9948122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist