Provider Demographics
NPI:1396759353
Name:MCDERMOTT, JAMES HARRY (DDS)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:HARRY
Last Name:MCDERMOTT
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 1:904 S 2ND ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-2702
Mailing Address - Country:US
Mailing Address - Phone:217-528-2341
Mailing Address - Fax:217-528-0012
Practice Address - Street 1:904 S 2ND ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-2702
Practice Address - Country:US
Practice Address - Phone:217-528-2341
Practice Address - Fax:217-528-0012
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL201711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice