Provider Demographics
NPI:1528284916
Name:HUPP, JAMES RICHARD (DMD, MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:RICHARD
Last Name:HUPP
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:LAKESIDE ANNEX 7 & 8 MAIL STOP 701
Mailing Address - Street 2:ECU-SCHOOL OF DENTAL MEDICINE
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834
Mailing Address - Country:US
Mailing Address - Phone:252-737-7000
Mailing Address - Fax:252-737-7049
Practice Address - Street 1:600 MOYE BLVD MAIL STOP 654
Practice Address - Street 2:GENERAL PRACTICE RESIDENCY
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834
Practice Address - Country:US
Practice Address - Phone:252-744-4618
Practice Address - Fax:252-744-2827
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOS363021223S0112X
NC8803122300000X
NC2009-01628204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0660447Medicaid