Provider Demographics
NPI:1366866717
Name:FJERSTAD, JAMES HAROLD (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:HAROLD
Last Name:FJERSTAD
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 1:1234 MALLARD BAYE
Mailing Address - Street 2:
Mailing Address - City:RUTLEDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37861-5982
Mailing Address - Country:US
Mailing Address - Phone:865-828-4599
Mailing Address - Fax:
Practice Address - Street 1:6500 S PADRE ISLAND DR
Practice Address - Street 2:SUITE #12
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78412-4065
Practice Address - Country:US
Practice Address - Phone:361-992-4800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-05
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7597122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist