Provider Demographics
NPI: | 1508067125 |
---|---|
Name: | JAMES R GARDEN DDS PA |
Entity Type: | Organization |
Organization Name: | JAMES R GARDEN DDS PA |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OFFICE MANAGER |
Authorized Official - Prefix: | MRS |
Authorized Official - First Name: | JENNIFER |
Authorized Official - Middle Name: | TABOR |
Authorized Official - Last Name: | PURKEY |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 704-845-5583 |
Mailing Address - Street 1: | 2505 PLANTATION CENTER DR |
Mailing Address - Street 2: | |
Mailing Address - City: | MATTHEWS |
Mailing Address - State: | NC |
Mailing Address - Zip Code: | 28105-5298 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 704-845-5583 |
Mailing Address - Fax: | 704-814-9275 |
Practice Address - Street 1: | 2505 PLANTATION CENTER DR |
Practice Address - Street 2: | |
Practice Address - City: | MATTHEWS |
Practice Address - State: | NC |
Practice Address - Zip Code: | 28105-5298 |
Practice Address - Country: | US |
Practice Address - Phone: | 704-845-5583 |
Practice Address - Fax: | 704-814-9275 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-05-30 |
Last Update Date: | 2020-08-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NC | 6764 | 122300000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 122300000X | Dental Providers | Dentist | Group - Single Specialty |