MEDICARE: ROCIO ESTREMADOYRO DENTAL CORPORATION

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	122300000X	Dentist

General Provider Information

NPI Number	:	1306521851
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROCIO ESTREMADOYRO DENTAL CORPORATION

Provider Business Mailing Address
First Line	:	3244 QUINCY AVE
Second Line	:
City	:	CLOVIS
State	:	CA
Zip	:	93619-8120
Country	:	US
Telephone Number	:	818-510-6458
Fax Number	:

Provider Business Practice Location Address
First Line	:	6425 N PALM AVE STE 105
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93704-1084
Country	:	US
Telephone Number	:	559-439-6425
Fax Number	:

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	RACHELLE L CARTWRIGHT
Credential	:
Telephone Number	:	360-949-2949

Provider Enumeration Date	:	06/21/2023
Last Update Date	:	06/21/2023

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