Healthcare Provider Details

I. General information

NPI: 1922580810
Provider Name (Legal Business Name): N. OZDER DENTAL PRACTICE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2018
Last Update Date: 11/19/2021
Certification Date: 11/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9349 FOOTHILL BLVD STE B
RANCHO CUCAMONGA CA
91730-3567
US

IV. Provider business mailing address

1530 E GOLDEN VALLEY WAY
FRESNO CA
93730-3587
US

V. Phone/Fax

Practice location:
  • Phone: 909-980-6363
  • Fax: 909-481-5675
Mailing address:
  • Phone: 661-202-0454
  • Fax: 559-475-0389

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: OWNER
Credential: DDS
Phone: 661-202-0454