Provider Demographics
NPI:1205087061
Name:HARGROVE, JAMES ERYK (DDS)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ERYK
Last Name:HARGROVE
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 1:158 MCGEHEE DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70815-5012
Mailing Address - Country:US
Mailing Address - Phone:225-275-0123
Mailing Address - Fax:
Practice Address - Street 1:600 N HIGHWAY 190 STE 4
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-5083
Practice Address - Country:US
Practice Address - Phone:985-893-5522
Practice Address - Fax:985-871-0742
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-09
Last Update Date:2008-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5884122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1063657476OtherNPI ORGANIZATION NUMBER