Healthcare Provider Details

I. General information

NPI: 1982797825
Provider Name (Legal Business Name): SCOTT JOHN FIMBRES DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 04/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 E HERNDON AVE STE 119
FRESNO CA
93720-3100
US

IV. Provider business mailing address

1111 E HERNDON AVE STE 119
FRESNO CA
93720-3100
US

V. Phone/Fax

Practice location:
  • Phone: 559-431-4220
  • Fax: 559-432-9276
Mailing address:
  • Phone: 559-431-4220
  • Fax: 559-432-9276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number40435
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: