Provider Demographics
NPI:1902975345
Name:JAMES P MCCARTHY DMD PA
Entity Type:Organization
Organization Name:JAMES P MCCARTHY DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT - OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:P
Authorized Official - Last Name:MCCARTHY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:704-867-7988
Mailing Address - Street 1:1349 E GARRISON BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-5142
Mailing Address - Country:US
Mailing Address - Phone:704-867-7988
Mailing Address - Fax:704-867-5211
Practice Address - Street 1:1349 E GARRISON BLVD STE A
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-5142
Practice Address - Country:US
Practice Address - Phone:704-867-7988
Practice Address - Fax:704-867-5211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2532261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC95646OtherBLUECROSSBLUESHIELD
NC8995646Medicaid