Provider Demographics
NPI:1144383340
Name:JAMES, JON WILLIAM (DDS)
Entity Type:Individual
Prefix:MR
First Name:JON
Middle Name:WILLIAM
Last Name:JAMES
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 1:703 VIGO STREET
Mailing Address - Street 2:
Mailing Address - City:VINCENNES
Mailing Address - State:IN
Mailing Address - Zip Code:47591-2831
Mailing Address - Country:US
Mailing Address - Phone:812-882-4084
Mailing Address - Fax:
Practice Address - Street 1:703 VIGO STREET
Practice Address - Street 2:
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591-2831
Practice Address - Country:US
Practice Address - Phone:812-882-4084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12008001A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist