Healthcare Provider Details

I. General information

NPI: 1568520740
Provider Name (Legal Business Name): SUNILKUMAR RAMADAS KADABA D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 11/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23370 ROAD 22
CHOWCHILLA CA
93610-1501
US

IV. Provider business mailing address

5344 W OSPREY WAY
FRESNO CA
93722-8724
US

V. Phone/Fax

Practice location:
  • Phone: 559-665-5531
  • Fax:
Mailing address:
  • Phone: 559-274-0975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number50931
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: