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Individual
JAMES ANDREW MACK
Active
Individual
JAMES ANDREW MACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
14659
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
130585604
—
TX
01
—
89T822
BLUE CROSS BLUE SHIELD
TX
Enumeration date
10/02/2006
Last updated
06/14/2021
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