Provider Demographics
NPI:1114767019
Name:DALGARN, JAMES LEE III (DMD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:LEE
Last Name:DALGARN
Suffix:III
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 1:5820 SWIFT ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29582-9427
Mailing Address - Country:US
Mailing Address - Phone:814-207-7173
Mailing Address - Fax:
Practice Address - Street 1:901 16TH AVE
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-3013
Practice Address - Country:US
Practice Address - Phone:814-207-7173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCDGD.107821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice