Provider Demographics
NPI:1134236532
Name:JAMES, BART L (DDS)
Entity type:Individual
Prefix:DR
First Name:BART
Middle Name:L
Last Name:JAMES
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 1:4400 WARREN SHARON RD
Mailing Address - Street 2:P.O. BOX 458
Mailing Address - City:VIENNA
Mailing Address - State:OH
Mailing Address - Zip Code:44473-8616
Mailing Address - Country:US
Mailing Address - Phone:330-394-1672
Mailing Address - Fax:330-394-1376
Practice Address - Street 1:4400 WARREN SHARON RD
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:OH
Practice Address - Zip Code:44473-8616
Practice Address - Country:US
Practice Address - Phone:330-394-1672
Practice Address - Fax:330-394-1376
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2012-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH219561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2605327Medicaid