Provider Demographics
NPI:1881841252
Name:DUDUM, DARYL JAMES (DDS)
Entity Type:Individual
Prefix:DR
First Name:DARYL
Middle Name:JAMES
Last Name:DUDUM
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 1:3495 FREEMAN RD
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94595-1311
Mailing Address - Country:US
Mailing Address - Phone:310-266-6515
Mailing Address - Fax:415-898-0563
Practice Address - Street 1:1748 NOVATO BLVD STE 200
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94947-7855
Practice Address - Country:US
Practice Address - Phone:415-898-7093
Practice Address - Fax:415-898-0563
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-27
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10267122300000X
TX252881223E0200X
CA577311223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist