Provider Demographics
NPI:1265433239
Name:GROGAN, JAMES TILLMAN JR (DDS)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:TILLMAN
Last Name:GROGAN
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:800 W ELDORADO PKWY
Mailing Address - Street 2:#124
Mailing Address - City:LITTLE ELM
Mailing Address - State:TX
Mailing Address - Zip Code:75068
Mailing Address - Country:US
Mailing Address - Phone:972-292-3820
Mailing Address - Fax:972-292-3802
Practice Address - Street 1:800 W ELDORADO PKWY
Practice Address - Street 2:#124
Practice Address - City:LITTLE ELM
Practice Address - State:TX
Practice Address - Zip Code:75068
Practice Address - Country:US
Practice Address - Phone:972-292-3820
Practice Address - Fax:972-292-3802
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7939122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist