Provider Demographics
NPI:1922272731
Name:JAMES A. BEDOR, DDS, PC
Entity Type:Organization
Organization Name:JAMES A. BEDOR, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCINTYRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-698-8330
Mailing Address - Street 1:95 N WILLIAMS LAKE RD
Mailing Address - Street 2:
Mailing Address - City:WHITE LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48386-2557
Mailing Address - Country:US
Mailing Address - Phone:248-698-8330
Mailing Address - Fax:248-698-8333
Practice Address - Street 1:95 N WILLIAMS LAKE RD
Practice Address - Street 2:
Practice Address - City:WHITE LAKE
Practice Address - State:MI
Practice Address - Zip Code:48386-2557
Practice Address - Country:US
Practice Address - Phone:248-698-8330
Practice Address - Fax:248-698-8333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1722904Medicaid
MIJ801327OtherBCBS
MIU49173Medicare UPIN