Provider Demographics
NPI:1174512313
Name:ATEN, JAMES CRAIG (DDS)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:CRAIG
Last Name:ATEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:JIM
Other - Middle Name:CRAIG
Other - Last Name:ATEN
Other - Suffix:I
Other - Last Name Type:Other Name
Other - Credentials:DDS, M S
Mailing Address - Street 1:438 W. SEED FARM RD .
Mailing Address - Street 2:
Mailing Address - City:SACATON
Mailing Address - State:AZ
Mailing Address - Zip Code:85147-0038
Mailing Address - Country:US
Mailing Address - Phone:602-528-1200
Mailing Address - Fax:602-528-1255
Practice Address - Street 1:438 W SEED FARM RD
Practice Address - Street 2:
Practice Address - City:SACATON
Practice Address - State:AZ
Practice Address - Zip Code:85147-0038
Practice Address - Country:US
Practice Address - Phone:602-528-1209
Practice Address - Fax:602-528-1245
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ26981223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ771734Medicaid