Healthcare Provider Details

I. General information

NPI: 1417167230
Provider Name (Legal Business Name): WAYNE V. HOTZAKORGIAN D.D.S., M.SC.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 05/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6307 N. FRESNO ST., STE 102
FRESNO CA
93710
US

IV. Provider business mailing address

6307 N. FRESNO ST., STE. 102
FRESNO CA
93710
US

V. Phone/Fax

Practice location:
  • Phone: 559-224-5423
  • Fax: 559-224-5957
Mailing address:
  • Phone: 559-224-5423
  • Fax: 559-224-5957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number25808
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: