Provider Demographics
NPI:1598059339
Name:DUGHMAN, WADIE O (DMD)
Entity Type:Individual
Prefix:DR
First Name:WADIE
Middle Name:O
Last Name:DUGHMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2651 BLANDING AVE STE L
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-1588
Mailing Address - Country:US
Mailing Address - Phone:510-521-0420
Mailing Address - Fax:
Practice Address - Street 1:2651 BLANDING AVE
Practice Address - Street 2:SUITE L
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-1580
Practice Address - Country:US
Practice Address - Phone:510-521-0420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-08
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61231122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist