Healthcare Provider Details

I. General information

NPI: 1295855534
Provider Name (Legal Business Name): JAMES KENNETH BRIGHAM DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

334 SHAW SUITE 130
CLOVIS CA
93612
US

IV. Provider business mailing address

1797 PORTALS AVE
CLOVIS CA
93611
US

V. Phone/Fax

Practice location:
  • Phone: 559-298-7500
  • Fax: 559-298-5600
Mailing address:
  • Phone: 559-299-1945
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number24216
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: