Provider Demographics
NPI:1851485916
Name:STAUDHAMMER, DEBRA JUNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:JUNE
Last Name:STAUDHAMMER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4018 BLACKHAWK PLAZA CIR
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94506-4654
Mailing Address - Country:US
Mailing Address - Phone:925-736-9860
Mailing Address - Fax:925-736-9865
Practice Address - Street 1:4018 BLACKHAWK PLAZA CIR
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94506-4654
Practice Address - Country:US
Practice Address - Phone:925-936-9860
Practice Address - Fax:925-736-9865
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41130122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist