Healthcare Provider Details

I. General information

NPI: 1124160304
Provider Name (Legal Business Name): STEVE D O'HARA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7770 N FRESNO ST 101
FRESNO CA
93720-2412
US

IV. Provider business mailing address

1763 E WALLINGTON LN
FRESNO CA
93720-3596
US

V. Phone/Fax

Practice location:
  • Phone: 559-432-7777
  • Fax: 559-432-7791
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number46666
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: