Healthcare Provider Details

I. General information

NPI: 1336382845
Provider Name (Legal Business Name): JAMES RUSSELL DURHAM DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2009
Last Update Date: 04/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7559C HIGHWAY 72 WEST SUITE 105
MADISON AL
35758-8812
US

IV. Provider business mailing address

7559C HIGHWAY 72 WEST SUITE 105
MADISON AL
35758-8812
US

V. Phone/Fax

Practice location:
  • Phone: 256-325-0078
  • Fax: 256-325-0079
Mailing address:
  • Phone: 256-325-0078
  • Fax: 256-325-0079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number5521
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: