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General NPI Number Information
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NPI Number | 1659847549
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Entity Type | Organization
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Legal Business Name | S MAVI,D.D.S., INCORPORATED
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Dates
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Enumeration Date | 10/17/2018
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Last Update Date | 10/17/2018
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Provider Practice Location Address
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Address Line | 4007 N MARKS AVE STE 102
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City | FRESNO
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State | CA
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Zip | 93722-4555
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Country | US
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Telephone | 559-225-5800
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Fax |
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Provider Business Mailing Address
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Address Line | 4007 N MARKS AVE STE 102
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City | FRESNO
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State | CA
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Zip | 93722-4555
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Country | US
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Telephone | 559-225-5800
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | VARINDER PANNU
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Credential | DDS
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Telephone | 206-225-9296
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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