Provider Demographics
NPI:1689299174
Name:AMIR, JAMES (DMD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:
Last Name:AMIR
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 PACKANACK LAKE RD
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-7400
Mailing Address - Country:US
Mailing Address - Phone:973-694-8625
Mailing Address - Fax:973-872-0073
Practice Address - Street 1:95 PACKANACK LAKE RD
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-7400
Practice Address - Country:US
Practice Address - Phone:973-694-8625
Practice Address - Fax:973-872-0073
Is Sole Proprietor?:No
Enumeration Date:2020-06-10
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN24856122300000X
NJ22DI02799300122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist