Provider Demographics
NPI:1477897734
Name:MCLAUGHLIN, JAMES BRYAN (DMD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:BRYAN
Last Name:MCLAUGHLIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BLDG 128 CHAFFEE ROAD
Mailing Address - Street 2:USA DENTAC
Mailing Address - City:FT BLISS
Mailing Address - State:TX
Mailing Address - Zip Code:79916
Mailing Address - Country:US
Mailing Address - Phone:915-742-5935
Mailing Address - Fax:915-742-5174
Practice Address - Street 1:6901 HELEN OF TROY STE C
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79911-3049
Practice Address - Country:US
Practice Address - Phone:915-581-8070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-26
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8145122300000X, 1223P0700X
TX327131223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
No122300000XDental ProvidersDentist