Provider Demographics
NPI:1417250382
Name:JIM IVERSTINE, D.D.S., APC
Entity Type:Organization
Organization Name:JIM IVERSTINE, D.D.S., APC
Other - Org Name:JIM IVERSTINE, D.D.S., APC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:V
Authorized Official - Last Name:IVERSTINE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:318-757-4561
Mailing Address - Street 1:207 SERIO BLVD
Mailing Address - Street 2:
Mailing Address - City:FERRIDAY
Mailing Address - State:LA
Mailing Address - Zip Code:71334-2014
Mailing Address - Country:US
Mailing Address - Phone:318-757-4561
Mailing Address - Fax:318-757-4595
Practice Address - Street 1:207 SERIO BLVD
Practice Address - Street 2:
Practice Address - City:FERRIDAY
Practice Address - State:LA
Practice Address - Zip Code:71334-2014
Practice Address - Country:US
Practice Address - Phone:318-757-4561
Practice Address - Fax:318-757-4595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-14
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1834190Medicaid