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General NPI Number Information
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NPI Number | 1669598975
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Entity Type | Organization
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Legal Business Name | MID VALLEY DENTAL CARE
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Dates
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Enumeration Date | 03/21/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4035 N FRESNO ST STE 105
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City | FRESNO
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State | CA
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Zip | 93726-4041
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Country | US
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Telephone | 559-228-9300
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Fax | 559-228-9302
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Provider Business Mailing Address
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Address Line | 4035 N FRESNO ST STE 105
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City | FRESNO
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State | CA
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Zip | 93726-4041
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Country | US
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Telephone | 559-228-9300
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Fax | 559-228-9302
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Authorized Official
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Title or Position | DENTIST
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Name | DR. REY QUIJANO YULIONGSIU
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Credential | D.D.S.
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Telephone | 559-228-9300
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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 | 46158
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License Number State | CA
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