Healthcare Provider Details

I. General information

NPI: 1295811800
Provider Name (Legal Business Name): ANDREW ROBERT RAHN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1313 E HERNDON AVE STE 104
FRESNO CA
93720-3306
US

IV. Provider business mailing address

1313 E HERNDON AVE STE 104
FRESNO CA
93720-3306
US

V. Phone/Fax

Practice location:
  • Phone: 559-435-7993
  • Fax: 559-435-7935
Mailing address:
  • Phone: 559-435-7993
  • Fax: 559-435-7935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number43553
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: