Provider Demographics
NPI:1316002389
Name:ALCORN, JAMES (DMD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:
Last Name:ALCORN
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 1:5455 W 11000 N STE 103
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:UT
Mailing Address - Zip Code:84003-8801
Mailing Address - Country:US
Mailing Address - Phone:801-492-0055
Mailing Address - Fax:801-492-0504
Practice Address - Street 1:5455 W 11000 N STE 103
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:UT
Practice Address - Zip Code:84003-8801
Practice Address - Country:US
Practice Address - Phone:801-492-0055
Practice Address - Fax:801-492-0504
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT53298821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice