Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 10761 | MO |
NPI | 1073673083 |
---|---|
Provider Name | Dr. James A Dryden |
First Address | Fayetteville, AR 72702-1034 |
Second Address | Joplin, MO 64804-2526 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2006 |
Last Update Date | 07/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10761 | CIGNA DENTAL PAR (01) | |
10761 | DELTA DENTAL (01) | |
1700470971 | CONNECTION DENTAL NETWORK (01) | |
460264 | BCBS DENTAL NON-PAR (01) | |
660586 | UNITED CONCORDIA NONPAR (01) |