Provider Demographics
NPI:1336286483
Name:MEAD, JAMES MACLENNAN (DMD, MPH)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MACLENNAN
Last Name:MEAD
Suffix:
Gender:M
Credentials:DMD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11980 SAN VICENTE BLVD STE 813
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-6606
Mailing Address - Country:US
Mailing Address - Phone:310-454-4672
Mailing Address - Fax:
Practice Address - Street 1:11980 SAN VICENTE BLVD STE 813
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-6606
Practice Address - Country:US
Practice Address - Phone:310-820-6323
Practice Address - Fax:310-820-5224
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA325911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice