Provider Demographics
NPI:1861877508
Name:JAMES C. MCALLISTER DDS, INC
Entity type:Organization
Organization Name:JAMES C. MCALLISTER DDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:CLARENCE
Authorized Official - Last Name:MCALLISTER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-357-8548
Mailing Address - Street 1:135 N SHORTRIDGE RD
Mailing Address - Street 2:SUITE B-5
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4900
Mailing Address - Country:US
Mailing Address - Phone:317-357-8548
Mailing Address - Fax:317-357-8546
Practice Address - Street 1:135 N SHORTRIDGE RD
Practice Address - Street 2:SUITE B-5
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-4900
Practice Address - Country:US
Practice Address - Phone:317-357-8548
Practice Address - Fax:317-357-8546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-23
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12006764122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100048150Medicaid