Healthcare Provider Details

I. General information

NPI: 1285399006
Provider Name (Legal Business Name): EDNA LOERA DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2021
Last Update Date: 11/05/2021
Certification Date: 11/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 M ST
FRESNO CA
93721-1805
US

IV. Provider business mailing address

1962 TAMARACK AVE
SANGER CA
93657-2053
US

V. Phone/Fax

Practice location:
  • Phone: 559-600-8241
  • Fax:
Mailing address:
  • Phone: 559-618-1647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number107080
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: