Healthcare Provider Details

I. General information

NPI: 1376744821
Provider Name (Legal Business Name): BRUCE J FREMMING DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 07/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 SHAW AVE SUITE E
CLOVIS CA
93612-3800
US

IV. Provider business mailing address

280 SHAW AVE SUITE E
CLOVIS CA
93612-3800
US

V. Phone/Fax

Practice location:
  • Phone: 559-299-9561
  • Fax: 559-299-5264
Mailing address:
  • Phone: 559-299-9561
  • Fax: 559-299-5264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number20183
License Number StateCA

VIII. Authorized Official

Name: BRUCE J FREMMING
Title or Position: OWNER
Credential: DDS
Phone: 559-299-9561