Active NPI
Daryl James Dudum, D.D.S.
- Endodontics
- Novato, CA
National Provider Identifier
1881841252
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- 57731
- Practice address
- 1748 Novato Blvd Ste 200
Novato, CA 94947-7855 - Phone
- (415) 898-7093
- Fax
- (415) 898-0563
- NPI assigned
- Aug 27, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 10267 | MA | |
| Endodontics | 1223E0200X | 25288 | TX | |
| Endodontics | 1223E0200X | 57731 | CA | Primary |
Addresses
Primary practice location
1748 Novato Blvd Ste 200
Novato, CA 94947-7855
Mailing address
3495 Freeman Rd
Walnut Creek, CA 94595-1311
Phone (310) 266-6515
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150624001975 | CA | Order and Referring Only - Dentist | 1658682109 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25288 | TX | MD | Endodontist |
| 10267 | MA | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Daryl Dudum DDS Inc | Endodontics | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Endodontics
- Novato, CA
- NPI 1669381489
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1219795200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1395878400000",
"number": "1881841252",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3495 FREEMAN RD",
"city": "WALNUT CREEK",
"state": "CA",
"postal_code": "945951311",
"telephone_number": "310-266-6515",
"fax_number": "415-898-0563"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1748 NOVATO BLVD STE 200",
"city": "NOVATO",
"state": "CA",
"postal_code": "949477855",
"telephone_number": "415-898-7093",
"fax_number": "415-898-0563"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DUDUM",
"first_name": "DARYL",
"middle_name": "JAMES",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-08-27",
"last_updated": "2014-03-27",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MA",
"license": "10267",
"primary": false
},
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "TX",
"license": "25288",
"primary": false
},
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "CA",
"license": "57731",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Novato, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.