Provider Demographics
NPI:1104483817
Name:CALL, JAMES BRANDON (DDS)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:BRANDON
Last Name:CALL
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 1:1352 E CENTER ST STE B
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-4769
Mailing Address - Country:US
Mailing Address - Phone:208-233-2500
Mailing Address - Fax:208-233-1025
Practice Address - Street 1:135 WARREN AVE
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-4621
Practice Address - Country:US
Practice Address - Phone:208-237-6453
Practice Address - Fax:208-233-1025
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-29
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-50311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice