Healthcare Provider Details

I. General information

NPI: 1720032378
Provider Name (Legal Business Name): MAYVIC CONTE DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 04/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 N BRIDGE ST
VISALIA CA
93291-5014
US

IV. Provider business mailing address

801 W CENTER AVE
VISALIA CA
93291-6013
US

V. Phone/Fax

Practice location:
  • Phone: 559-734-1939
  • Fax: 559-734-4384
Mailing address:
  • Phone: 559-791-7049
  • Fax: 559-734-1247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number46772
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: