Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 3148 | AR |
NPI | 1124149059 |
---|---|
Provider Name | Dr. James Charles Tinnin |
First Address | Fayetteville, AR 72703-2615 |
Second Address | Fayetteville, AR 72703-2615 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2007 |
Last Update Date | 08/07/2007 |