Provider Demographics
NPI:1104090380
Name:JAMES R. STRAIT, D.M.D. M.S
Entity type:Organization
Organization Name:JAMES R. STRAIT, D.M.D. M.S
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:STRAIT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-451-5740
Mailing Address - Street 1:4536 CHAMBLEE DUNWOODY RD STE 100
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30338-6203
Mailing Address - Country:US
Mailing Address - Phone:770-451-5740
Mailing Address - Fax:770-451-3516
Practice Address - Street 1:4536 CHAMBLEE DUNWOODY RD STE 100
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338-6203
Practice Address - Country:US
Practice Address - Phone:770-451-5740
Practice Address - Fax:770-451-3516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0076491223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty