Healthcare Provider Details

I. General information

NPI: 1437287604
Provider Name (Legal Business Name): JAMES D PRIGMORE DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 10/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1357 OLIVER ROAD
FAIRFIELD CA
94534
US

IV. Provider business mailing address

1357 OLIVER ROAD
FAIRFIELD CA
94534
US

V. Phone/Fax

Practice location:
  • Phone: 707-422-3500
  • Fax: 707-422-2301
Mailing address:
  • Phone: 707-422-3500
  • Fax: 707-422-2301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number24050
License Number StateCA

VIII. Authorized Official

Name: JAMES D PRIGMORE
Title or Position: PRESIDENT
Credential: DDS
Phone: 707-422-3500