Provider Demographics
NPI:1447247036
Name:MIRE, JAMES P (DDS)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:P
Last Name:MIRE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:102 MYSTIC BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-2761
Mailing Address - Country:US
Mailing Address - Phone:985-868-5337
Mailing Address - Fax:985-868-3575
Practice Address - Street 1:102 MYSTIC BLVD
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-2761
Practice Address - Country:US
Practice Address - Phone:985-868-5337
Practice Address - Fax:985-868-3575
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAOC00738122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223G0001XDental ProvidersDentistGeneral Practice