Provider Demographics
NPI:1174891121
Name:JAMES G BARSAMIAN DMD PA
Entity type:Organization
Organization Name:JAMES G BARSAMIAN DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DMD OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:G
Authorized Official - Last Name:BARSAMIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:904-246-6545
Mailing Address - Street 1:472 JACKSONVILLE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-3812
Mailing Address - Country:US
Mailing Address - Phone:904-246-6545
Mailing Address - Fax:904-246-3817
Practice Address - Street 1:472 JACKSONVILLE DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-3812
Practice Address - Country:US
Practice Address - Phone:904-246-6545
Practice Address - Fax:904-246-3817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-06
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00086611223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT87809Medicare UPIN