Provider Demographics
NPI:1295849370
Name:DURAN, EDDON (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDDON
Middle Name:
Last Name:DURAN
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 1:4138 DYER ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:UNION CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94587-3975
Mailing Address - Country:US
Mailing Address - Phone:151-048-7031
Mailing Address - Fax:151-048-7038
Practice Address - Street 1:4138 DYER ST
Practice Address - Street 2:SUITE 2
Practice Address - City:UNION CITY
Practice Address - State:CA
Practice Address - Zip Code:94587-3975
Practice Address - Country:US
Practice Address - Phone:151-048-7031
Practice Address - Fax:151-048-7038
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAD223411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAD22341OtherDENTAL STATE LICENSE