Healthcare Provider Details

I. General information

NPI: 1669866695
Provider Name (Legal Business Name): JORDAN PRIETO DDS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2015
Last Update Date: 03/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6245 N FRESNO ST STE 103
FRESNO CA
93710-5270
US

IV. Provider business mailing address

6245 N FRESNO ST STE 103
FRESNO CA
93710-5270
US

V. Phone/Fax

Practice location:
  • Phone: 559-554-9999
  • Fax:
Mailing address:
  • Phone: 559-554-9999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number StateCA

VIII. Authorized Official

Name: DR. JORDAN DAVID PRIETO
Title or Position: DDS/OWNER
Credential: DDS
Phone: 559-906-0209