Provider Demographics
NPI:1225204357
Name:MUMFORD, JAMES PATRICK (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:PATRICK
Last Name:MUMFORD
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 1:1600 N BETHLEHEM PIKE
Mailing Address - Street 2:SUITE S-120
Mailing Address - City:LOWER GWYNEDD
Mailing Address - State:PA
Mailing Address - Zip Code:19002-1427
Mailing Address - Country:US
Mailing Address - Phone:215-628-2828
Mailing Address - Fax:215-628-2453
Practice Address - Street 1:1600 N BETHLEHEM PIKE
Practice Address - Street 2:SUITE S-120
Practice Address - City:LOWER GWYNEDD
Practice Address - State:PA
Practice Address - Zip Code:19002-1427
Practice Address - Country:US
Practice Address - Phone:215-628-2828
Practice Address - Fax:215-628-2453
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-08
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-030888-L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist