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General NPI Number Information
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NPI Number | 1316158140
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Entity Type | Organization
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Legal Business Name | JAMES B. DUHAMEL, DENTAL CORPORATION
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Dates
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Enumeration Date | 05/24/2007
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Last Update Date | 04/29/2019
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Provider Practice Location Address
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Address Line | 1420 S MILLS AVE STE G
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City | LODI
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State | CA
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Zip | 95242-4291
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Country | US
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Telephone | 209-365-1110
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Fax | 209-772-8666
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Provider Business Mailing Address
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Address Line | PO BOX 607
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City | VALLEY SPRINGS
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State | CA
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Zip | 95252-0607
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Country | US
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Telephone | 209-772-9600
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Fax | 209-772-8666
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Authorized Official
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Title or Position | OWNER
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Name | DR. JAMES BRIAN DUHAMEL
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Credential | DDS
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Telephone | 209-772-9600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 23820
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number | 23820
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License Number State | CA
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