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General NPI Number Information
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NPI Number | 1093367054
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Entity Type | Organization
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Legal Business Name | I J BAYRAKDARIAN DMD A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 07/10/2019
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Last Update Date | 07/25/2019
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Provider Practice Location Address
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Address Line | 1479 W LACEY BLVD
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City | HANFORD
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State | CA
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Zip | 93230-5906
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Country | US
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Telephone | 559-222-2522
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Fax | 559-222-3022
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Provider Business Mailing Address
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Address Line | 1616 W SHAW AVE STE A6
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City | FRESNO
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State | CA
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Zip | 93711-3513
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Country | US
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Telephone | 559-222-2522
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Fax | 559-222-3022
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Authorized Official
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Title or Position | ASSISTANT MANAGER
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Name | ANGIE BURUCA
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Credential |
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Telephone | 559-222-2522
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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