Provider Demographics
NPI:1992718035
Name:PICKENS, JAMES BAIRD (DMD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:BAIRD
Last Name:PICKENS
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 1:706 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:KY
Mailing Address - Zip Code:42071-1943
Mailing Address - Country:US
Mailing Address - Phone:270-753-5052
Mailing Address - Fax:270-753-1637
Practice Address - Street 1:706 MAIN ST
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071-1943
Practice Address - Country:US
Practice Address - Phone:270-753-5052
Practice Address - Fax:270-753-1637
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY60561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60060563Medicaid