Provider Demographics
NPI:1972637502
Name:MCALLISTER, JAMES CLARENCE (DDS)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:CLARENCE
Last Name:MCALLISTER
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 1:135 N SHORTRIDGE RD STE B5
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-8905
Mailing Address - Country:US
Mailing Address - Phone:317-357-8548
Mailing Address - Fax:317-357-8546
Practice Address - Street 1:135 N SHORTRIDGE RD STE B5
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-8905
Practice Address - Country:US
Practice Address - Phone:317-357-8548
Practice Address - Fax:317-357-8546
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12006764A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100048150AMedicaid
IN35-141-2708OtherTAX ID #
IN35-141-2708OtherTAX ID #