Provider Demographics
NPI:1649925561
Name:BINGHAM, DAVID J (DDS)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:BINGHAM
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 1:2535 N 4000 W
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:ID
Mailing Address - Zip Code:83232-5134
Mailing Address - Country:US
Mailing Address - Phone:208-851-0618
Mailing Address - Fax:
Practice Address - Street 1:3335 S HOLMES AVE
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-7981
Practice Address - Country:US
Practice Address - Phone:208-524-3770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-18
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-5387122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist