Provider Demographics
NPI:1730525809
Name:JAMES, MICHAEL ANTHONY (DDS)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ANTHONY
Last Name:JAMES
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 1:1271 ISLAND HARBOR DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-8998
Mailing Address - Country:US
Mailing Address - Phone:901-634-7516
Mailing Address - Fax:
Practice Address - Street 1:2026 EXETER RD STE 2
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-3965
Practice Address - Country:US
Practice Address - Phone:901-538-7201
Practice Address - Fax:901-538-7202
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-16
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY057594122300000X
390200000X
TN104821223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
No122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty