Provider Demographics
NPI:1013080274
Name:WILLARDSEN, JAMES ARTHUR (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ARTHUR
Last Name:WILLARDSEN
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 1:2575 N 5TH ST
Mailing Address - Street 2:STE A
Mailing Address - City:ELKO
Mailing Address - State:NV
Mailing Address - Zip Code:89801-5092
Mailing Address - Country:US
Mailing Address - Phone:775-738-9666
Mailing Address - Fax:775-738-6815
Practice Address - Street 1:2575 N 5TH ST
Practice Address - Street 2:STE A
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801-5092
Practice Address - Country:US
Practice Address - Phone:775-738-9666
Practice Address - Fax:775-738-6815
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV32241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV880425856OtherTAX ID NUMBER