Provider Demographics
NPI:1578954228
Name:DEFINNIS, JAMES CLEMENS (DMD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:CLEMENS
Last Name:DEFINNIS
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 1:210 CARVERTON RD
Mailing Address - Street 2:
Mailing Address - City:TRUCKSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18708-1745
Mailing Address - Country:US
Mailing Address - Phone:570-696-1105
Mailing Address - Fax:
Practice Address - Street 1:210 CARVERTON RD
Practice Address - Street 2:
Practice Address - City:TRUCKSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18708-1745
Practice Address - Country:US
Practice Address - Phone:570-696-1105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-16
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-031113-L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist