Provider Demographics
NPI:1104933316
Name:HUONI, JAMES M SR (DMD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:M
Last Name:HUONI
Suffix:SR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 NO BROAD STREET
Mailing Address - Street 2:
Mailing Address - City:LELAND
Mailing Address - State:MS
Mailing Address - Zip Code:38756
Mailing Address - Country:US
Mailing Address - Phone:662-686-2009
Mailing Address - Fax:
Practice Address - Street 1:305 NO BROAD STREET
Practice Address - Street 2:
Practice Address - City:LELAND
Practice Address - State:MS
Practice Address - Zip Code:38756
Practice Address - Country:US
Practice Address - Phone:662-686-2009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1891 80122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00060133Medicaid