Provider Demographics
NPI:1326145467
Name:SHOPTAW, JAMES THOMAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:THOMAS
Last Name:SHOPTAW
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 1:2305 MARLANDWOOD RD
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-2846
Mailing Address - Country:US
Mailing Address - Phone:254-699-4543
Mailing Address - Fax:
Practice Address - Street 1:120 W CENTRAL TEXAS EXPY STE 200
Practice Address - Street 2:
Practice Address - City:HARKER HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:76548-7406
Practice Address - Country:US
Practice Address - Phone:254-699-4543
Practice Address - Fax:254-699-4538
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103531223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX556122OtherUNITED CONCORDIA
TX111273202Medicaid