Provider Demographics
NPI:1609963875
Name:WALLINGFORD, JAMES (DDS, FAGD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:
Last Name:WALLINGFORD
Suffix:
Gender:M
Credentials:DDS, FAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17156 W FM 1097
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MONTGOMERY
Mailing Address - State:TX
Mailing Address - Zip Code:77356
Mailing Address - Country:US
Mailing Address - Phone:936-597-4333
Mailing Address - Fax:936-597-4355
Practice Address - Street 1:17156 W FM 1097
Practice Address - Street 2:SUITE 2
Practice Address - City:MONTGOMERY
Practice Address - State:TX
Practice Address - Zip Code:77356
Practice Address - Country:US
Practice Address - Phone:936-597-4333
Practice Address - Fax:936-597-4355
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX209091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice