Provider Demographics
NPI:1326297102
Name:LAUDERDALE, JAMES A III (DD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:A
Last Name:LAUDERDALE
Suffix:III
Gender:M
Credentials:DD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2321 16TH ST
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301-4031
Mailing Address - Country:US
Mailing Address - Phone:601-693-4544
Mailing Address - Fax:
Practice Address - Street 1:2321 16TH ST
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-4031
Practice Address - Country:US
Practice Address - Phone:601-693-4544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-16
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1722 761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice