Provider Demographics
NPI:1184752123
Name:JAMES R. STROUD D.D.S., INC
Entity type:Organization
Organization Name:JAMES R. STROUD D.D.S., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:STROUD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:805-937-1812
Mailing Address - Street 1:1103 E CLARK AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93455-5144
Mailing Address - Country:US
Mailing Address - Phone:805-937-1812
Mailing Address - Fax:
Practice Address - Street 1:1103 E CLARK AVE
Practice Address - Street 2:SUITE B
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93455-5144
Practice Address - Country:US
Practice Address - Phone:805-937-1812
Practice Address - Fax:805-937-7756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA248731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty