Provider Demographics
NPI:1568471654
Name:JAMES C. BAWDEN III, D.D.S. INC.
Entity Type:Organization
Organization Name:JAMES C. BAWDEN III, D.D.S. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:CLINTON
Authorized Official - Last Name:BAWDEN
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:707-429-9550
Mailing Address - Street 1:1700 PENNSYLVANIA AVE
Mailing Address - Street 2:SUITE D.
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-3588
Mailing Address - Country:US
Mailing Address - Phone:707-429-9550
Mailing Address - Fax:707-429-1465
Practice Address - Street 1:1700 PENNSYLVANIA AVE
Practice Address - Street 2:SUITE D.
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-3588
Practice Address - Country:US
Practice Address - Phone:707-429-9550
Practice Address - Fax:707-429-1465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA 25119261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental