Provider Demographics
NPI:1649593039
Name:INDIVERI, JAMES B (DMD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:B
Last Name:INDIVERI
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 1:300 NW R.D. MIZE ROAD
Mailing Address - Street 2:
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64014
Mailing Address - Country:US
Mailing Address - Phone:816-229-1245
Mailing Address - Fax:816-229-7555
Practice Address - Street 1:300 NW R.D. MIZE ROAD
Practice Address - Street 2:
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64014
Practice Address - Country:US
Practice Address - Phone:816-229-1245
Practice Address - Fax:816-229-7555
Is Sole Proprietor?:No
Enumeration Date:2010-03-12
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO810ORTHO1223X0400X
MO015196DENTAL1223X0400X
KS445ORTHO1223X0400X
KS6441DENTAL1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics