Provider Demographics
NPI:1629287115
Name:POPOVICH, JAMES GABRIEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:GABRIEL
Last Name:POPOVICH
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 1:223 S COURT ST
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-3951
Mailing Address - Country:US
Mailing Address - Phone:219-663-0252
Mailing Address - Fax:219-663-3249
Practice Address - Street 1:223 S COURT ST
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-3951
Practice Address - Country:US
Practice Address - Phone:219-663-0252
Practice Address - Fax:219-663-3249
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120066341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice