Provider Demographics
NPI:1063570695
Name:MAGILL, JAMES BRECK (DDS)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:BRECK
Last Name:MAGILL
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 1:209 COMMERCE CT
Mailing Address - Street 2:
Mailing Address - City:ELKHORN
Mailing Address - State:WI
Mailing Address - Zip Code:53121-4371
Mailing Address - Country:US
Mailing Address - Phone:262-723-2900
Mailing Address - Fax:
Practice Address - Street 1:209 COMMERCE CT
Practice Address - Street 2:
Practice Address - City:ELKHORN
Practice Address - State:WI
Practice Address - Zip Code:53121-4371
Practice Address - Country:US
Practice Address - Phone:262-723-2900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI22761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice