Provider Demographics
NPI:1457438673
Name:LICHTSINN, JAMES BRIAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:BRIAN
Last Name:LICHTSINN
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 1:3210 18TH ST S STE A
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-6789
Mailing Address - Country:US
Mailing Address - Phone:701-280-1941
Mailing Address - Fax:701-364-1943
Practice Address - Street 1:3210 18TH ST S STE A
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-6789
Practice Address - Country:US
Practice Address - Phone:701-280-1941
Practice Address - Fax:701-364-1943
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1777122300000X
MND9478122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist