Provider Demographics
NPI:1215961271
Name:THURMOND, JAMES ALLAN (DDS)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ALLAN
Last Name:THURMOND
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 1:6349 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CUBA
Mailing Address - State:NM
Mailing Address - Zip Code:87013-1915
Mailing Address - Country:US
Mailing Address - Phone:505-289-3291
Mailing Address - Fax:
Practice Address - Street 1:6349 MAIN STREET
Practice Address - Street 2:
Practice Address - City:CUBA
Practice Address - State:NM
Practice Address - Zip Code:87013-0608
Practice Address - Country:US
Practice Address - Phone:505-289-3291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM11041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice