Healthcare Provider Details

I. General information

NPI: 1639085368
Provider Name (Legal Business Name): NAMALA DENTAL GROUP OF FRESNO INCOR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5731 N FRESNO ST STE 103
FRESNO CA
93710-6075
US

IV. Provider business mailing address

3385 G ST STE B
MERCED CA
95340-0980
US

V. Phone/Fax

Practice location:
  • Phone: 559-616-7629
  • Fax: 559-616-7681
Mailing address:
  • Phone: 559-616-7629
  • Fax: 559-616-7681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MONICA HERNANDEZ
Title or Position: OM
Credential:
Phone: 559-367-6130