Provider Demographics
NPI:1811970254
Name:HOMRIGHAUSEN, JAMES KEITH (DMD)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:KEITH
Last Name:HOMRIGHAUSEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5120 CHARLESTOWN RD
Mailing Address - Street 2:STE 1
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-9497
Mailing Address - Country:US
Mailing Address - Phone:812-944-4000
Mailing Address - Fax:812-944-4505
Practice Address - Street 1:5120 CHARLESTOWN RD
Practice Address - Street 2:STE 1
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-9497
Practice Address - Country:US
Practice Address - Phone:812-944-4000
Practice Address - Fax:812-944-4505
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-21
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120100041223S0112X, 204E00000X
KY72131223S0112X, 204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1129756Medicaid
KY60072139Medicaid
KY64072135Medicaid
IN200161030Medicaid
KY0005804Medicaid
IN150500Medicare ID - Type Unspecified
U80423Medicare UPIN