Provider Demographics
NPI:1518935147
Name:VADEN, JAMES L (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:L
Last Name:VADEN
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-3319
Mailing Address - Country:US
Mailing Address - Phone:931-526-3717
Mailing Address - Fax:
Practice Address - Street 1:308 E 1ST ST
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-3319
Practice Address - Country:US
Practice Address - Phone:931-526-3717
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS0021421223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0006626OtherTENNCARE PROVIDER NUMBER