Provider Demographics
NPI:1336303296
Name:DUGGAN, DAVID MICHAEL (DDS, PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MICHAEL
Last Name:DUGGAN
Suffix:
Gender:M
Credentials:DDS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1076 SANTO ANTONIO DR
Mailing Address - Street 2:SUITE K
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-8103
Mailing Address - Country:US
Mailing Address - Phone:909-824-7179
Mailing Address - Fax:909-824-2730
Practice Address - Street 1:1076 SANTO ANTONIO DR
Practice Address - Street 2:SUITE K
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-8103
Practice Address - Country:US
Practice Address - Phone:909-824-7179
Practice Address - Fax:909-824-2730
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-10
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA400741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice