Provider Demographics
NPI:1518971704
Name:CIRGIN, JAMES TAYLOR (DDS)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:TAYLOR
Last Name:CIRGIN
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 1:51 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:IN
Mailing Address - Zip Code:47460-1311
Mailing Address - Country:US
Mailing Address - Phone:812-829-2261
Mailing Address - Fax:812-829-2263
Practice Address - Street 1:51 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:IN
Practice Address - Zip Code:47460-1311
Practice Address - Country:US
Practice Address - Phone:812-829-2261
Practice Address - Fax:812-829-2263
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN7115122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist