Provider Demographics
NPI:1336215797
Name:MANSFIELD, JAMES DARRELL (DDS)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:DARRELL
Last Name:MANSFIELD
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 367
Mailing Address - Street 2:
Mailing Address - City:ALBEMARLE
Mailing Address - State:NC
Mailing Address - Zip Code:28002
Mailing Address - Country:US
Mailing Address - Phone:704-983-6111
Mailing Address - Fax:704-983-4560
Practice Address - Street 1:1907 HIGHWAY 52 N
Practice Address - Street 2:
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001
Practice Address - Country:US
Practice Address - Phone:704-983-6111
Practice Address - Fax:704-983-4560
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC6698122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist