Provider Demographics
NPI:1346398872
Name:MCGILL, JAMES ROGER (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ROGER
Last Name:MCGILL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1421 WAYZATA BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WAYZATA
Mailing Address - State:MN
Mailing Address - Zip Code:55391-1939
Mailing Address - Country:US
Mailing Address - Phone:952-473-1521
Mailing Address - Fax:952-252-0889
Practice Address - Street 1:1421 WAYZATA BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:WAYZATA
Practice Address - State:MN
Practice Address - Zip Code:55391-1939
Practice Address - Country:US
Practice Address - Phone:952-473-1521
Practice Address - Fax:952-252-0889
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MND105041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice