Provider Demographics
NPI:1508126772
Name:JOERN, JAMES ALBERT (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ALBERT
Last Name:JOERN
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 1:1711 INVESTORS AVE
Mailing Address - Street 2:
Mailing Address - City:EL RENO
Mailing Address - State:OK
Mailing Address - Zip Code:73036-1607
Mailing Address - Country:US
Mailing Address - Phone:405-262-1919
Mailing Address - Fax:405-563-9374
Practice Address - Street 1:1711 INVESTORS AVE
Practice Address - Street 2:
Practice Address - City:EL RENO
Practice Address - State:OK
Practice Address - Zip Code:73036-1607
Practice Address - Country:US
Practice Address - Phone:405-262-1919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-22
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK63951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice