Provider Demographics
NPI:1073856910
Name:STROUD, JAMES R (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:R
Last Name:STROUD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 E CLARK AVE
Mailing Address - Street 2:STE B
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93455-5144
Mailing Address - Country:US
Mailing Address - Phone:805-937-1812
Mailing Address - Fax:805-937-7756
Practice Address - Street 1:1103 E CLARK AVE
Practice Address - Street 2:STE B
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93455-5144
Practice Address - Country:US
Practice Address - Phone:805-937-1812
Practice Address - Fax:805-937-7756
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-28
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA248731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice