Healthcare Provider Details

I. General information

NPI: 1639736762
Provider Name (Legal Business Name): OZDER DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2019
Last Update Date: 06/21/2022
Certification Date: 06/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 SHAW AVE
CLOVIS CA
93612-3985
US

IV. Provider business mailing address

1330 SHAW AVE
CLOVIS CA
93612-3985
US

V. Phone/Fax

Practice location:
  • Phone: 661-202-0454
  • Fax:
Mailing address:
  • Phone: 661-202-0454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: NECDET OZDER
Title or Position: OWNER
Credential: DDS
Phone: 559-255-1122