Provider Demographics
NPI:1467584854
Name:DAVID A. DURHAM DDS AND ASSOCIATES PC
Entity Type:Organization
Organization Name:DAVID A. DURHAM DDS AND ASSOCIATES PC
Other - Org Name:SOUTHWEST ORAL SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGG
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:HOSCH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:314-822-3322
Mailing Address - Street 1:10000 WATSON RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63126-1854
Mailing Address - Country:US
Mailing Address - Phone:314-822-3322
Mailing Address - Fax:314-822-0537
Practice Address - Street 1:10000 WATSON RD
Practice Address - Street 2:SUITE A
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63126-1854
Practice Address - Country:US
Practice Address - Phone:314-822-3322
Practice Address - Fax:314-822-0537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO140541223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty