Healthcare Provider Details

I. General information

NPI: 1619632080
Provider Name (Legal Business Name): OZDER DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2021
Last Update Date: 11/01/2021
Certification Date: 11/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2745 W SHAW AVE STE 103
FRESNO CA
93711-3315
US

IV. Provider business mailing address

1530 E GOLDEN VALLEY WAY
FRESNO CA
93730-3587
US

V. Phone/Fax

Practice location:
  • Phone: 559-227-2900
  • Fax:
Mailing address:
  • Phone: 559-475-0357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NECDET OZDER
Title or Position: CEO
Credential: DDS
Phone: 559-255-1122