Provider Demographics
NPI:1528148277
Name:DEWHURST, JAMES V (DDS)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:V
Last Name:DEWHURST
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 1:1606 W FIR ST
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:OK
Mailing Address - Zip Code:73077-5800
Mailing Address - Country:US
Mailing Address - Phone:580-336-6500
Mailing Address - Fax:580-336-6502
Practice Address - Street 1:1606 W FIR ST
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:OK
Practice Address - Zip Code:73077-5800
Practice Address - Country:US
Practice Address - Phone:580-336-6500
Practice Address - Fax:580-336-6502
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK49221223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100846170AMedicaid