Provider Demographics
NPI:1285741447
Name:MCDERMOTT, JAMES JOSEPH (DMD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:JOSEPH
Last Name:MCDERMOTT
Suffix:
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 1:5131 MAIN ST
Mailing Address - Street 2:STE 101
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507
Mailing Address - Country:US
Mailing Address - Phone:505-209-9080
Mailing Address - Fax:505-750-9982
Practice Address - Street 1:5131 MAIN ST
Practice Address - Street 2:STE 101
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507
Practice Address - Country:US
Practice Address - Phone:505-209-9080
Practice Address - Fax:505-750-9982
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD4465122300000X
MAMA152301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice