Provider Demographics
NPI:1891869525
Name:DUNHAM, FREDD HILTON (LAC, LMT)
Entity Type:Individual
Prefix:MR
First Name:FREDD
Middle Name:HILTON
Last Name:DUNHAM
Suffix:
Gender:M
Credentials:LAC, LMT
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 196
Mailing Address - Street 2:
Mailing Address - City:BUELLTON
Mailing Address - State:CA
Mailing Address - Zip Code:93427-0196
Mailing Address - Country:US
Mailing Address - Phone:805-455-5550
Mailing Address - Fax:805-686-9711
Practice Address - Street 1:1727 STATE ST
Practice Address - Street 2:27
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-2521
Practice Address - Country:US
Practice Address - Phone:805-455-5550
Practice Address - Fax:805-686-9711
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 10742171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist