Provider Demographics
NPI:1548434558
Name:JAMES E HEREFORD, DDS, INC
Entity type:Organization
Organization Name:JAMES E HEREFORD, DDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:HEREFORD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:918-371-3375
Mailing Address - Street 1:1111 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74021-3112
Mailing Address - Country:US
Mailing Address - Phone:918-371-3375
Mailing Address - Fax:918-371-4407
Practice Address - Street 1:1111 W MAIN ST
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:OK
Practice Address - Zip Code:74021-3112
Practice Address - Country:US
Practice Address - Phone:918-371-3375
Practice Address - Fax:918-371-4407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4112261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center