Healthcare Provider Details

I. General information

NPI: 1245470913
Provider Name (Legal Business Name): ADEEL ANWAR DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2009
Last Update Date: 10/07/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17008 13TH STREET
HURON CA
93234-9997
US

IV. Provider business mailing address

3875 W BEECHWOOD AVE
FRESNO CA
93711-0795
US

V. Phone/Fax

Practice location:
  • Phone: 800-492-4227
  • Fax: 559-646-3652
Mailing address:
  • Phone: 800-492-4227
  • Fax: 559-646-3652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberD7720
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number5952
License Number StateNV
# 3
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number58289
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: