Provider Demographics
NPI:1891129540
Name:AULTMAN, JAMES ALAN (DMD MS)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:ALAN
Last Name:AULTMAN
Suffix:
Gender:M
Credentials:DMD MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 57TH ST S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35212-2541
Mailing Address - Country:US
Mailing Address - Phone:205-591-1101
Mailing Address - Fax:
Practice Address - Street 1:100 57TH ST S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35212-2541
Practice Address - Country:US
Practice Address - Phone:205-591-1101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-29
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL6085122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist