Provider Demographics
NPI:1285645572
Name:HAVIRD, JAMES MICHAEL (DMD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:MICHAEL
Last Name:HAVIRD
Suffix:
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 1:1810 KNOX AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:NORTH AUGUSTA
Mailing Address - State:SC
Mailing Address - Zip Code:29841
Mailing Address - Country:US
Mailing Address - Phone:803-279-0015
Mailing Address - Fax:803-278-6578
Practice Address - Street 1:1810 KNOX AVE
Practice Address - Street 2:SUITE A
Practice Address - City:NORTH AUGUSTA
Practice Address - State:SC
Practice Address - Zip Code:29841
Practice Address - Country:US
Practice Address - Phone:803-279-0015
Practice Address - Fax:803-278-6578
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2109122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist