Healthcare Provider Details

I. General information

NPI: 1235673773
Provider Name (Legal Business Name): FRESNO DENTAL SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2016
Last Update Date: 12/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2828 FRESNO ST SUITE 100
FRESNO CA
93721-1327
US

IV. Provider business mailing address

2828 FRESNO ST SUITE 100
FRESNO CA
93721-1327
US

V. Phone/Fax

Practice location:
  • Phone: 559-263-9648
  • Fax: 559-263-9777
Mailing address:
  • Phone: 559-263-9648
  • Fax: 559-263-9777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RAYMOND FIGUEROA
Title or Position: PRESIDENT, CEO & SECRETARY
Credential:
Phone: 717-968-8729