Provider Demographics
NPI:1205360328
Name:WADIE DUGHMAN, DMD, INC.
Entity Type:Organization
Organization Name:WADIE DUGHMAN, DMD, INC.
Other - Org Name:DUGHMAN DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WADIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DUGHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:510-205-2621
Mailing Address - Street 1:2651 BLANDING AVE
Mailing Address - Street 2:SUITE L
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-1580
Mailing Address - Country:US
Mailing Address - Phone:510-521-0420
Mailing Address - Fax:
Practice Address - Street 1:2651 BLANDING AVE
Practice Address - Street 2:SUITE L
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-1580
Practice Address - Country:US
Practice Address - Phone:510-521-0420
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-14
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA612311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty