Provider Demographics
NPI:1639253727
Name:COVAN, JAMES E JR (DMD, MPH)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:E
Last Name:COVAN
Suffix:JR
Gender:M
Credentials:DMD, MPH
Other - Prefix:DR
Other - First Name:JAMES
Other - Middle Name:E
Other - Last Name:COVAN
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:7010 W HIGHWAY 98
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32506-5930
Mailing Address - Country:US
Mailing Address - Phone:850-455-0631
Mailing Address - Fax:850-455-4147
Practice Address - Street 1:7010 W HIGHWAY 98
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32506-5930
Practice Address - Country:US
Practice Address - Phone:850-455-0631
Practice Address - Fax:850-455-4147
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN121031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice