Provider Demographics
NPI:1750465118
Name:IVERSTINE, JAMES VICTOR (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:VICTOR
Last Name:IVERSTINE
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 1:207 SERIO BLVD
Mailing Address - Street 2:
Mailing Address - City:FERRIDAY
Mailing Address - State:LA
Mailing Address - Zip Code:71334-2014
Mailing Address - Country:US
Mailing Address - Phone:318-757-4561
Mailing Address - Fax:318-757-4595
Practice Address - Street 1:207 SERIO BLVD
Practice Address - Street 2:
Practice Address - City:FERRIDAY
Practice Address - State:LA
Practice Address - Zip Code:71334-2014
Practice Address - Country:US
Practice Address - Phone:318-757-4561
Practice Address - Fax:318-757-4595
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA34191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice