Provider Demographics
NPI:1508009515
Name:JAMES HAM DDS PROFESSIONAL DENTAL CORP
Entity Type:Organization
Organization Name:JAMES HAM DDS PROFESSIONAL DENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:HAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-704-6450
Mailing Address - Street 1:23101 SHERMAN PL
Mailing Address - Street 2:SUITE 520
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-2003
Mailing Address - Country:US
Mailing Address - Phone:818-704-6450
Mailing Address - Fax:818-704-6454
Practice Address - Street 1:23101 SHERMAN PL
Practice Address - Street 2:SUITE 520
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-2003
Practice Address - Country:US
Practice Address - Phone:818-704-6450
Practice Address - Fax:818-704-6454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-07
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD197441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty