Provider Demographics
NPI:1972560829
Name:KILCOYNE, JAMES MICHAEL (DDS)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MICHAEL
Last Name:KILCOYNE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9109 BAYMEADOWS RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-2014
Mailing Address - Country:US
Mailing Address - Phone:904-731-0311
Mailing Address - Fax:904-731-0312
Practice Address - Street 1:9109 BAYMEADOWS RD
Practice Address - Street 2:SUITE 4
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-2014
Practice Address - Country:US
Practice Address - Phone:904-731-0311
Practice Address - Fax:904-731-0312
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 60281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice