Healthcare Provider Details

I. General information

NPI: 1467682815
Provider Name (Legal Business Name): THAAR DHIA ALDOURI D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2009
Last Update Date: 02/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4901 E KINGS CANYON RD
FRESNO CA
93727-3812
US

IV. Provider business mailing address

4901 E KINGS CANYON RD
FRESNO CA
93727-3812
US

V. Phone/Fax

Practice location:
  • Phone: 559-490-1343
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number66585
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number63186
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number21303
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: