Healthcare Provider Details

I. General information

NPI: 1093335713
Provider Name (Legal Business Name): CHILDREN'S DENTISTRY OF MERCED A DENTAL OFFICE OF STEVEN O'HARA, DDS,
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2020
Last Update Date: 04/22/2020
Certification Date: 04/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 PARK AVE
MERCED CA
95348-3421
US

IV. Provider business mailing address

6245 N FRESNO ST STE 103
FRESNO CA
93710-5270
US

V. Phone/Fax

Practice location:
  • Phone: 559-554-9999
  • Fax:
Mailing address:
  • Phone: 559-554-9999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: STEVEN O'HARA
Title or Position: OWNER/PRESIDENT
Credential: DDS
Phone: 559-554-9999