Provider Demographics
NPI:1770790008
Name:SOUERS, JAMES LOREN
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:LOREN
Last Name:SOUERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 E KELSEY ST
Mailing Address - Street 2:
Mailing Address - City:THREE RIVERS
Mailing Address - State:MI
Mailing Address - Zip Code:49093-1503
Mailing Address - Country:US
Mailing Address - Phone:269-273-9595
Mailing Address - Fax:269-278-8071
Practice Address - Street 1:111 E KELSEY ST
Practice Address - Street 2:
Practice Address - City:THREE RIVERS
Practice Address - State:MI
Practice Address - Zip Code:49093-1503
Practice Address - Country:US
Practice Address - Phone:269-273-9595
Practice Address - Fax:269-278-8071
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010100331223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics