Provider Demographics
NPI:1891842209
Name:KATIB, JAMES M (DMD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:M
Last Name:KATIB
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:343 ESSEX ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01840-1410
Mailing Address - Country:US
Mailing Address - Phone:978-685-8600
Mailing Address - Fax:978-687-3311
Practice Address - Street 1:343 ESSEX ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01840-1410
Practice Address - Country:US
Practice Address - Phone:978-685-8600
Practice Address - Fax:978-687-3311
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2015-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA203061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0202011Medicaid
1553204OtherUNITED CONCORDIA
X11729OtherBLUE CROSS BLUE SHIELD MA