Provider Demographics
NPI:1467543421
Name:DUKE, DAVID L (DDS)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:DUKE
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 1:1263 PLEASANT GROVE BLVD STE 150
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95747-5858
Mailing Address - Country:US
Mailing Address - Phone:916-784-2002
Mailing Address - Fax:916-784-1116
Practice Address - Street 1:1263 PLEASANT GROVE BLVD STE 150
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95747-5858
Practice Address - Country:US
Practice Address - Phone:916-784-2002
Practice Address - Fax:916-784-1116
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA343271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice