Provider Demographics
NPI:1134158595
Name:BEDOR, JAMES ALAN (DDS)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ALAN
Last Name:BEDOR
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 1:95 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
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI131241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
38-2659681OtherFEIN
MI1722904Medicaid
MI13124OtherLICENSE
MIAB2086886OtherDEA
MI13124OtherLICENSE