Provider Demographics
NPI:1538268495
Name:JAMES A. ABBOTT, D.D.S., M.S.
Entity type:Organization
Organization Name:JAMES A. ABBOTT, D.D.S., M.S.
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:ALLEN
Authorized Official - Last Name:ABBOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:707-523-3636
Mailing Address - Street 1:2755 MENDOCINO AVENUE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403
Mailing Address - Country:US
Mailing Address - Phone:707-523-3636
Mailing Address - Fax:707-523-3693
Practice Address - Street 1:4655 HOEN AVENUE
Practice Address - Street 2:SUITE 2
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405
Practice Address - Country:US
Practice Address - Phone:707-523-3636
Practice Address - Fax:707-523-3693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD024525122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty