Healthcare Provider Details

I. General information

NPI: 1962699777
Provider Name (Legal Business Name): SCOTT J. FIMBRES, D.D.S., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2007
Last Update Date: 08/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7585 N COLONIAL AVE STE 105
FRESNO CA
93711
US

IV. Provider business mailing address

7585 N COLONIAL AVE STE 105
FRESNO CA
93711-5889
US

V. Phone/Fax

Practice location:
  • Phone: 559-431-4220
  • Fax: 559-431-9276
Mailing address:
  • Phone: 559-431-4220
  • Fax: 559-431-9276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. KRISTIE LEA MILLER
Title or Position: OFFICE MANAGER
Credential:
Phone: 559-431-4220