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General NPI Number Information
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NPI Number | 1669866695
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Entity Type | Organization
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Legal Business Name | JORDAN PRIETO DDS, INC.
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Dates
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Enumeration Date | 03/27/2015
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Last Update Date | 03/27/2015
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Provider Practice Location Address
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Address Line | 6245 N FRESNO ST STE 103
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City | FRESNO
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State | CA
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Zip | 93710-5270
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Country | US
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Telephone | 559-554-9999
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Fax |
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Provider Business Mailing Address
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Address Line | 6245 N FRESNO ST STE 103
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City | FRESNO
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State | CA
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Zip | 93710-5270
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Country | US
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Telephone | 559-554-9999
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Fax |
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Authorized Official
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Title or Position | DDS/OWNER
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Name | DR. JORDAN DAVID PRIETO
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Credential | DDS
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Telephone | 559-906-0209
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State | CA
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