Healthcare Provider Details

I. General information

NPI: 1699052886
Provider Name (Legal Business Name): DOWNTOWN DENTAL SURGERY CENTER OF FRESNO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2011
Last Update Date: 11/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1045 S ST
FRESNO CA
93721-1406
US

IV. Provider business mailing address

2838 MARIPOSA ST
FRESNO CA
93721-1308
US

V. Phone/Fax

Practice location:
  • Phone: 559-266-2005
  • Fax: 888-630-8881
Mailing address:
  • Phone: 831-212-2123
  • Fax: 888-630-8881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. SHELBY JOBE
Title or Position: PRESIDENT
Credential:
Phone: 831-212-2123