MEDICARE: HEAD AND NECK ASSOCIATES OF CENTRAL CALIFORNIA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)
2	204E00000X	Oral & Maxillofacial Surgery (D.M.D.)

General Provider Information

NPI Number	:	1073173860
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEAD AND NECK ASSOCIATES OF CENTRAL CALIFORNIA

Provider Business Mailing Address
First Line	:	215 N FRESNO ST STE 490
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93701-0000
Country	:	US
Telephone Number	:	559-459-4101
Fax Number	:	559-459-5744

Provider Business Practice Location Address
First Line	:	215 N FRESNO ST STE 490
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93701-0000
Country	:	US
Telephone Number	:	559-459-4101
Fax Number	:	559-459-5744

Authorized Official
Title or Position	:	GEN PARTNER
Name	:	BRIAN MICHAEL WOO
Credential	:	DDS, MD
Telephone Number	:	559-459-4101

Provider Enumeration Date	:	06/14/2019
Last Update Date	:	05/28/2024

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Directions to “HEAD AND NECK ASSOCIATES OF CENTRAL CALIFORNIA ” Practice Location

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