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General NPI Number Information
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NPI Number | 1568471654
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Entity Type | Organization
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Legal Business Name | JAMES C. BAWDEN III, D.D.S. INC.
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Dates
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Enumeration Date | 08/07/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1700 PENNSYLVANIA AVE SUITE D.
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City | FAIRFIELD
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State | CA
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Zip | 94533-3588
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Country | US
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Telephone | 707-429-9550
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Fax | 707-429-1465
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Provider Business Mailing Address
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Address Line | 1700 PENNSYLVANIA AVE SUITE D.
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City | FAIRFIELD
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State | CA
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Zip | 94533-3588
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Country | US
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Telephone | 707-429-9550
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Fax | 707-429-1465
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. JAMES CLINTON BAWDEN III
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Credential | D.D.S.
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Telephone | 707-429-9550
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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 | CA 25119
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License Number State | CA
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