Provider Demographics
NPI:1356386676
Name:RANSDELL, JAMES M (DDS)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:M
Last Name:RANSDELL
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 1:2750 W WIGWAM AVE
Mailing Address - Street 2:APT# 1207
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-6643
Mailing Address - Country:US
Mailing Address - Phone:702-366-3797
Mailing Address - Fax:928-718-2106
Practice Address - Street 1:1751 N STOCKTON HILL RD
Practice Address - Street 2:STE# A
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86401-6601
Practice Address - Country:US
Practice Address - Phone:928-718-8668
Practice Address - Fax:928-718-2106
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD67571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ094746Medicare ID - Type UnspecifiedAHCCCS