Provider Demographics
NPI:1457410839
Name:SIEMENS, JAMES VERNON (DDS)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:VERNON
Last Name:SIEMENS
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 1:4509 S MOUNT ANGELES RD
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-8913
Mailing Address - Country:US
Mailing Address - Phone:360-457-5771
Mailing Address - Fax:
Practice Address - Street 1:104 W 3RD ST
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-2825
Practice Address - Country:US
Practice Address - Phone:360-452-9744
Practice Address - Fax:360-452-5861
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000050311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA55180-06Medicaid