Provider Demographics
NPI:1851569677
Name:JAMES M PHELAN, DMD
Entity Type:Organization
Organization Name:JAMES M PHELAN, DMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:PHELAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-761-5320
Mailing Address - Street 1:3 HOWARTH AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02703-5926
Mailing Address - Country:US
Mailing Address - Phone:508-761-5320
Mailing Address - Fax:
Practice Address - Street 1:3 HOWARTH AVE
Practice Address - Street 2:
Practice Address - City:SOUTH ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-5926
Practice Address - Country:US
Practice Address - Phone:508-761-5320
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-14
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA155731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty