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General NPI Number Information
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NPI Number | 1275957037
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Entity Type | Individual
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Provider Name | KEVIN FURMANEK DDS, MD
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Gender | Male
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Dates
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Enumeration Date | 02/13/2014
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Last Update Date | 09/29/2020
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Provider Practice Location Address
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Address Line | 3900 SISK RD STE O
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City | MODESTO
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State | CA
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Zip | 95356-3229
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Country | US
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Telephone | 209-857-3910
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Fax |
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Provider Business Mailing Address
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Address Line | 980 VIA TREVISO
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City | EL DORADO HILLS
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State | CA
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Zip | 95762-7245
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 170067
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License Number State | CA
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