Healthcare Provider Details

I. General information

NPI: 1023924909
Provider Name (Legal Business Name): LIVING WATER DENTAL CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 S MIRAGE AVE
LINDSAY CA
93247-2543
US

IV. Provider business mailing address

222 W HENDERSON AVE
PORTERVILLE CA
93257-1731
US

V. Phone/Fax

Practice location:
  • Phone: 559-562-5969
  • Fax:
Mailing address:
  • Phone: 559-784-5483
  • Fax: 559-789-9828

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: ERICK MADRIGAL
Title or Position: CEO
Credential: MD
Phone: 559-784-5483