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General NPI Number Information
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NPI Number | 1639602428
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Entity Type | Organization
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Legal Business Name | BAYRAKDARIAN CLOVIS I, D.M.D., INC., A PROFESSIONAL DENTAL CORPORATION
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Dates
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Enumeration Date | 04/07/2017
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Last Update Date | 05/21/2025
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Provider Practice Location Address
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Address Line | 451 CLOVIS AVE STE 105
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City | CLOVIS
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State | CA
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Zip | 93612-1197
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Country | US
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Telephone | 559-298-4322
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Fax | 559-298-5827
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Provider Business Mailing Address
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Address Line | 6688 N CEDAR AVE
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City | FRESNO
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State | CA
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Zip | 93710-4401
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Country | US
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Telephone | 559-837-1063
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Fax | 559-578-8274
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Authorized Official
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Title or Position | ENROLLMENT OFFICER
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Name | DIANE WRIGHT
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Credential |
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Telephone | 559-578-8274
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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 | 50037
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License Number State | CA
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