Provider Demographics
NPI:1417094392
Name:VLASSIS, JAMES M (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:M
Last Name:VLASSIS
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 1:100 N BURDICK ST
Mailing Address - Street 2:PO BOX 296
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13066-1319
Mailing Address - Country:US
Mailing Address - Phone:315-637-0777
Mailing Address - Fax:315-637-2337
Practice Address - Street 1:100 N BURDICK ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13066-1319
Practice Address - Country:US
Practice Address - Phone:315-637-0777
Practice Address - Fax:315-637-2337
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042985-11223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics