Provider Demographics
NPI:1265456826
Name:TRANTHAM, JAMES GEORGE IV (DMD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:GEORGE
Last Name:TRANTHAM
Suffix:IV
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 1:1704 AIRPORT BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-4313
Mailing Address - Country:US
Mailing Address - Phone:321-473-5414
Mailing Address - Fax:321-952-1469
Practice Address - Street 1:1704 AIRPORT BLVD STE A
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901
Practice Address - Country:US
Practice Address - Phone:321-473-5414
Practice Address - Fax:321-952-1469
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN175701223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist