Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 9722 | NC |
NPI | 1003228800 |
---|---|
Provider Name | Dr. James Jorge |
First Address | Wilmington, NC 28411-4764 |
Second Address | Durham, NC 27704-2619 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2014 |
Last Update Date | 13/10/2019 |