Provider Demographics
NPI:1467542001
Name:LA, JAMES T (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:T
Last Name:LA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 MATLOCK RD STE 103
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-2900
Mailing Address - Country:US
Mailing Address - Phone:817-468-3590
Mailing Address - Fax:972-513-9191
Practice Address - Street 1:3100 MATLOCK RD STE 103
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-2900
Practice Address - Country:US
Practice Address - Phone:817-468-3590
Practice Address - Fax:817-468-4500
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX193231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1467542001OtherDENTAL