Provider Demographics
NPI:1134149834
Name:ALDRIDGE, JAMES NIGHBERT JR (DDS)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:NIGHBERT
Last Name:ALDRIDGE
Suffix:JR
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 1:350 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-1812
Mailing Address - Country:US
Mailing Address - Phone:304-523-3666
Mailing Address - Fax:304-623-3762
Practice Address - Street 1:350 5TH AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-1812
Practice Address - Country:US
Practice Address - Phone:304-523-3666
Practice Address - Fax:304-623-3762
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV26021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0136890000Medicaid
OH0617630Medicaid