Provider Demographics
NPI:1457674699
Name:BAINER, DAVID JAMES (D,D,S,)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JAMES
Last Name:BAINER
Suffix:
Gender:M
Credentials:D,D,S,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:591 CAMINO DE LA REINA
Mailing Address - Street 2:SUITE 412
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3102
Mailing Address - Country:US
Mailing Address - Phone:619-220-7475
Mailing Address - Fax:619-220-7484
Practice Address - Street 1:591 CAMINO DE LA REINA
Practice Address - Street 2:SUITE 412
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3102
Practice Address - Country:US
Practice Address - Phone:619-220-7475
Practice Address - Fax:619-220-7484
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-02
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58390122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist