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General NPI Number Information
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NPI Number | 1598259459
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Entity Type | Organization
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Legal Business Name | DENTURE & IMPLANT CENTERS OF AMERICA
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Dates
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Enumeration Date | 06/14/2018
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Last Update Date | 12/29/2021
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Provider Practice Location Address
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Address Line | 6495 N. PALM AVE ST #105
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City | FRESNO
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State | CA
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Zip | 93704
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Country | US
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Telephone | 559-277-3001
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Fax | 559-277-3031
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Provider Business Mailing Address
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Address Line | 6495 N. PALM AVE ST #105
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City | FRESNO
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State | CA
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Zip | 93704
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Country | US
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Telephone | 559-277-3001
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Fax | 559-277-3031
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Authorized Official
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Title or Position | OWNER - DENTIST
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Name | MR. MARK LEONARD DAVIS
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Credential | D.D.S.
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Telephone | 559-277-3001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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