Provider Demographics
NPI:1457381584
Name:KISER, JAMES DALE JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:DALE
Last Name:KISER
Suffix:JR
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 1:5110 WILLIAMSBURG RD
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5113
Mailing Address - Country:US
Mailing Address - Phone:707-880-8659
Mailing Address - Fax:
Practice Address - Street 1:210 ENON SPRINGS RD E
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-3011
Practice Address - Country:US
Practice Address - Phone:615-459-3162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24838122300000X
LA5114122300000X
WADE00008151122300000X
ORD8219122300000X
TX19322122300000X
CA65197122300000X
TN9978122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist