Provider Demographics
NPI:1235468166
Name:JAMES T SHOPTAW DDS
Entity Type:Organization
Organization Name:JAMES T SHOPTAW DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:T
Authorized Official - Last Name:SHOPTAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-760-2988
Mailing Address - Street 1:3200 BELLMEAD DRIVE
Mailing Address - Street 2:
Mailing Address - City:BELLMEAD
Mailing Address - State:TX
Mailing Address - Zip Code:76705
Mailing Address - Country:US
Mailing Address - Phone:254-799-4000
Mailing Address - Fax:254-799-4035
Practice Address - Street 1:3200 BELLMEAD DRIVE
Practice Address - Street 2:
Practice Address - City:BELLMEAD
Practice Address - State:TX
Practice Address - Zip Code:76705
Practice Address - Country:US
Practice Address - Phone:254-799-4000
Practice Address - Fax:254-799-4035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-24
Last Update Date:2009-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103531223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty