Provider Demographics
NPI:1699947812
Name:DU BOSE, JAMES E (DMD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:E
Last Name:DU BOSE
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 1:416 E SPRING ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:GA
Mailing Address - Zip Code:30655-2350
Mailing Address - Country:US
Mailing Address - Phone:770-267-6822
Mailing Address - Fax:770-267-0928
Practice Address - Street 1:416 E SPRING ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:GA
Practice Address - Zip Code:30655-2350
Practice Address - Country:US
Practice Address - Phone:770-267-6822
Practice Address - Fax:770-267-0928
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-27
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA8266122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00051708AMedicaid
GA1316058159OtherGROUP NPI