Provider Demographics
NPI:1063519700
Name:DYKSTRA, JAMES HOWARD (DDS)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:HOWARD
Last Name:DYKSTRA
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 1:1 DUKE CT
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07656-2209
Mailing Address - Country:US
Mailing Address - Phone:201-476-0472
Mailing Address - Fax:
Practice Address - Street 1:1 PARK ST
Practice Address - Street 2:SUITE 1
Practice Address - City:HARRINGTON PARK
Practice Address - State:NJ
Practice Address - Zip Code:07640-1905
Practice Address - Country:US
Practice Address - Phone:201-768-0106
Practice Address - Fax:201-768-0107
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI01473400122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist