Healthcare Provider Details

I. General information

NPI: 1962070698
Provider Name (Legal Business Name): CHILDREN'S DENTISTRY OF VISALIA A DENTAL OFFICE OF STEPHEN O'HARA, DDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2021
Last Update Date: 06/17/2021
Certification Date: 06/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1941 N DINUBA BLVD STE A
VISALIA CA
93291-3011
US

IV. Provider business mailing address

1900 SHAW AVE STE 101
CLOVIS CA
93611-4209
US

V. Phone/Fax

Practice location:
  • Phone: 559-554-9999
  • Fax:
Mailing address:
  • Phone: 559-439-5300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

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