Provider Demographics
NPI:1205839289
Name:SEXTON, JAMES H JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:H
Last Name:SEXTON
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4416 WANDO FARMS RD
Mailing Address - Street 2:
Mailing Address - City:AWENDAW
Mailing Address - State:SC
Mailing Address - Zip Code:29429-6143
Mailing Address - Country:US
Mailing Address - Phone:843-817-7417
Mailing Address - Fax:
Practice Address - Street 1:4416 WANDO FARMS RD
Practice Address - Street 2:
Practice Address - City:AWENDAW
Practice Address - State:SC
Practice Address - Zip Code:29429-6143
Practice Address - Country:US
Practice Address - Phone:843-817-7417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZ19631Medicaid
550838953OtherFEDERAL TAX ID