Provider Demographics
NPI:1487958500
Name:MACK, JAMES CA (DDS)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:CA
Last Name:MACK
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 1:110 HIGHLAND AVENUE
Mailing Address - Street 2:P.O. BOX 65
Mailing Address - City:NEW STANTON
Mailing Address - State:PA
Mailing Address - Zip Code:15672
Mailing Address - Country:US
Mailing Address - Phone:724-925-6010
Mailing Address - Fax:724-925-8631
Practice Address - Street 1:110 HIGHLAND AVENUE
Practice Address - Street 2:
Practice Address - City:NEW STANTON
Practice Address - State:PA
Practice Address - Zip Code:15672
Practice Address - Country:US
Practice Address - Phone:724-925-6010
Practice Address - Fax:724-925-8631
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-04
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS020328L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice