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General NPI Number Information
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NPI Number | 1063598167
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Entity Type | Individual
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Provider Name | BENTON JAMES RUNQUIST D.D.S., M.S.
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Gender | Male
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Dates
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Enumeration Date | 10/31/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 635 ANDERSON RD SUITE #6
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City | DAVIS
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State | CA
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Zip | 95616-3505
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Country | US
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Telephone | 530-756-0220
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Fax | 530-758-3796
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Provider Business Mailing Address
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Address Line | 307 GRANDE AVE
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City | DAVIS
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State | CA
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Zip | 95616-0211
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Country | US
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Telephone | 530-757-6780
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Fax | 530-758-3796
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 33843
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License Number State | CA
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