Provider Demographics
NPI:1912082603
Name:JAMES J JERVINIS,D.M.D.,P.C.
Entity Type:Organization
Organization Name:JAMES J JERVINIS,D.M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:J
Authorized Official - Last Name:JERVINIS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:978-744-5912
Mailing Address - Street 1:393 ESSEX ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-3156
Mailing Address - Country:US
Mailing Address - Phone:978-744-5912
Mailing Address - Fax:978-744-3192
Practice Address - Street 1:393 ESSEX ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-3156
Practice Address - Country:US
Practice Address - Phone:978-744-5912
Practice Address - Fax:978-744-3192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA147771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty