Healthcare Provider Details

I. General information

NPI: 1780895995
Provider Name (Legal Business Name): GREG CHARLES NALCHAJIAN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7501 N FRESNO ST SUITE 105
FRESNO CA
93720-2458
US

IV. Provider business mailing address

7501 N FRESNO ST SUITE 105
FRESNO CA
93720-2458
US

V. Phone/Fax

Practice location:
  • Phone: 559-432-7100
  • Fax:
Mailing address:
  • Phone: 559-432-7100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number35435
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: