Provider Demographics
NPI:1225047384
Name:MACOVIAK, JAMES JOSEPH (DDS)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:JOSEPH
Last Name:MACOVIAK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 456
Mailing Address - Street 2:RITTENHOUSE PLACE
Mailing Address - City:DRUMS
Mailing Address - State:PA
Mailing Address - Zip Code:18222-0456
Mailing Address - Country:US
Mailing Address - Phone:570-788-7010
Mailing Address - Fax:570-788-5188
Practice Address - Street 1:ROUTE 309
Practice Address - Street 2:RITTENHOUSE PLACE B2
Practice Address - City:DRUMS
Practice Address - State:PA
Practice Address - Zip Code:18222-0456
Practice Address - Country:US
Practice Address - Phone:570-788-7010
Practice Address - Fax:570-788-5188
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS023630L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist