Provider Demographics
NPI:1659408722
Name:JAMES B. MACOMSON DDS, MSO,PA
Entity Type:Organization
Organization Name:JAMES B. MACOMSON DDS, MSO,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:B
Authorized Official - Last Name:MACOMSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSO
Authorized Official - Phone:704-867-3667
Mailing Address - Street 1:2605 ARMSTRONG CIR
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-7262
Mailing Address - Country:US
Mailing Address - Phone:704-867-2388
Mailing Address - Fax:
Practice Address - Street 1:1601 B EAST GARRISON BLVD.
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054
Practice Address - Country:US
Practice Address - Phone:704-867-3667
Practice Address - Fax:704-867-3415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC35821223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty