Healthcare Provider Details

I. General information

NPI: 1689861320
Provider Name (Legal Business Name): VENUS FANOUS D.D.S.,
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2007
Last Update Date: 09/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 QUEBEC AVE.
CORCORAN CA
93212-7100
US

IV. Provider business mailing address

11704 VALLEY FORGE WAY
BAKERSFIELD CA
93312-8288
US

V. Phone/Fax

Practice location:
  • Phone: 559-992-7100
  • Fax:
Mailing address:
  • Phone: 661-900-8442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number53319
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: