Healthcare Provider Details

I. General information

NPI: 1265768527
Provider Name (Legal Business Name): DAVID JOHN FRANCKUM D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2009
Last Update Date: 10/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2690 NE KRESKY AVE
CHEHALIS WA
98532-2412
US

IV. Provider business mailing address

2832 DANBURY LN SW #1332
TUMWATER WA
98512-8203
US

V. Phone/Fax

Practice location:
  • Phone: 360-330-9595
  • Fax: 360-330-9560
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE60118558
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: