Provider Demographics
NPI:1134208002
Name:STAFFORD, JAMES J (DDS)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:J
Last Name:STAFFORD
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 70
Mailing Address - Street 2:2670 HWY. 20
Mailing Address - City:VACHERIE
Mailing Address - State:LA
Mailing Address - Zip Code:70090-0070
Mailing Address - Country:US
Mailing Address - Phone:225-265-3026
Mailing Address - Fax:225-265-9804
Practice Address - Street 1:2670 HWY. 20
Practice Address - Street 2:
Practice Address - City:VACHERIE
Practice Address - State:LA
Practice Address - Zip Code:70090
Practice Address - Country:US
Practice Address - Phone:225-265-3026
Practice Address - Fax:225-265-9804
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4315122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist