Provider Demographics
NPI:1730408667
Name:DURHAM, DAVID LEWIS (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LEWIS
Last Name:DURHAM
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 1:16000 ALSDELL RD
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-5524
Mailing Address - Country:US
Mailing Address - Phone:540-314-1113
Mailing Address - Fax:
Practice Address - Street 1:11540 MIDLOTHIAN TPKE
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-4747
Practice Address - Country:US
Practice Address - Phone:804-594-6916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-17
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA0401412848122300000X
TNDS0000009596122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program