Provider Demographics
NPI:1952461261
Name:CARLEY, JAMES A (DDS)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:A
Last Name:CARLEY
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:PO BOX 468
Mailing Address - Street 2:1405 W REYNOLDS ST
Mailing Address - City:PONTIAC
Mailing Address - State:IL
Mailing Address - Zip Code:61764-0468
Mailing Address - Country:US
Mailing Address - Phone:815-842-4142
Mailing Address - Fax:815-842-1024
Practice Address - Street 1:1405 W REYNOLDS ST
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:IL
Practice Address - Zip Code:61764-0468
Practice Address - Country:US
Practice Address - Phone:815-842-4142
Practice Address - Fax:815-842-1024
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL01900168881223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics