Healthcare Provider Details

I. General information

NPI: 1033964333
Provider Name (Legal Business Name): BAYRAKDARIAN CEDAR, D.M.D., INC., A PROFESSIONAL DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2024
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6646 N CEDAR AVE
FRESNO CA
93710-4401
US

IV. Provider business mailing address

6688 N CEDAR AVE
FRESNO CA
93710-4401
US

V. Phone/Fax

Practice location:
  • Phone: 559-222-2522
  • Fax: 559-222-3022
Mailing address:
  • Phone: 559-837-1063
  • Fax: 559-222-3022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DIANE WRIGHT
Title or Position: ENROLLMENT OFFICER
Credential:
Phone: 559-578-8274