Provider Demographics
NPI:1801010848
Name:STATES, JAMES KOOPMAN (DDS)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:KOOPMAN
Last Name:STATES
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 1:112 W F ST
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-5345
Mailing Address - Country:US
Mailing Address - Phone:308-532-4142
Mailing Address - Fax:308-532-1655
Practice Address - Street 1:112 W F ST
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-5345
Practice Address - Country:US
Practice Address - Phone:308-532-4142
Practice Address - Fax:308-532-1655
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE39681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice