Provider Demographics
NPI:1588846596
Name:DEFFENBAUGH, JOHN LEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:LEE
Last Name:DEFFENBAUGH
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:PO BOX 4000
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95696-4000
Mailing Address - Country:US
Mailing Address - Phone:707-451-0182
Mailing Address - Fax:
Practice Address - Street 1:2100 PEABODY RD.
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95696-4000
Practice Address - Country:US
Practice Address - Phone:707-451-0182
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-30
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25505122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist