Provider Demographics
NPI:1962833699
Name:JAMES B. DUHAMEL, DENTAL CORPORATION
Entity Type:Organization
Organization Name:JAMES B. DUHAMEL, DENTAL CORPORATION
Other - Org Name:SLEEP DENTAL SERVICES - LODI, DENTAL GROUP OF JAMES B. DUHAMEL, DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:DUHAMEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:209-772-9600
Mailing Address - Street 1:PO BOX 607
Mailing Address - Street 2:
Mailing Address - City:VALLEY SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:95252-0607
Mailing Address - Country:US
Mailing Address - Phone:209-772-9600
Mailing Address - Fax:209-772-8666
Practice Address - Street 1:2200 MCHENRY AVE STE B
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-3255
Practice Address - Country:US
Practice Address - Phone:209-529-2726
Practice Address - Fax:209-772-8666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-05
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23820332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6366230001Medicare NSC