Individual
JAMES ANDREW MACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
3004 HG MOSLEY PKWY, LONGVIEW, TX 75605-2948
(903) 758-3444
(903) 758-1967
Mailing address
3004 HG MOSLEY PKWY, LONGVIEW, TX 75605-2948
(903) 758-3444
(903) 758-1967
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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