Provider Demographics
NPI:1407956345
Name:DAFFURN, RICHARD LEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:LEE
Last Name:DAFFURN
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 1:181 ANDRIEUX ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SONOMA
Mailing Address - State:CA
Mailing Address - Zip Code:95476-6932
Mailing Address - Country:US
Mailing Address - Phone:707-996-4585
Mailing Address - Fax:707-996-4059
Practice Address - Street 1:181 ANDRIEUX ST
Practice Address - Street 2:SUITE 104
Practice Address - City:SONOMA
Practice Address - State:CA
Practice Address - Zip Code:95476-6932
Practice Address - Country:US
Practice Address - Phone:707-996-4585
Practice Address - Fax:707-996-4059
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22059122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist