Provider Demographics
NPI:1689048738
Name:MACOMSON, JAMES BARRETT (DDS, MSO)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:BARRETT
Last Name:MACOMSON
Suffix:
Gender:M
Credentials:DDS, MSO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1601 E GARRISON BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-5139
Mailing Address - Country:US
Mailing Address - Phone:704-867-3667
Mailing Address - Fax:704-867-3415
Practice Address - Street 1:1601 E GARRISON BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-5139
Practice Address - Country:US
Practice Address - Phone:704-867-3667
Practice Address - Fax:704-867-3415
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-30
Last Update Date:2015-11-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC35821223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics