Provider Demographics
NPI:1265087498
Name:JAMES CANDON, DDS, LLC
Entity type:Organization
Organization Name:JAMES CANDON, DDS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:CANDON
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:802-999-8818
Mailing Address - Street 1:2012 BRIDGEMILL DR STE 108
Mailing Address - Street 2:
Mailing Address - City:INDIAN LAND
Mailing Address - State:SC
Mailing Address - Zip Code:29707-9221
Mailing Address - Country:US
Mailing Address - Phone:802-999-8818
Mailing Address - Fax:
Practice Address - Street 1:2012 BRIDGEMILL DRIVE
Practice Address - Street 2:SUITE 108
Practice Address - City:INDIAN LAND
Practice Address - State:SC
Practice Address - Zip Code:29707-2970
Practice Address - Country:US
Practice Address - Phone:802-999-8818
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-05
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental