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General NPI Number Information
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NPI Number | 1831341262
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Entity Type | Organization
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Legal Business Name | PLATINUM DENTAL OF HANFORD
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Dates
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Enumeration Date | 10/16/2008
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Last Update Date | 10/16/2008
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Provider Practice Location Address
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Address Line | 425 WEST 7TH STREET 106
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City | HANFORD
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State | CA
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Zip | 93230
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Country | US
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Telephone | 559-589-1119
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Fax |
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Provider Business Mailing Address
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Address Line | 425 WEST 7TH STREET 106
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City | HANFORD
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State | CA
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Zip | 93230
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Country | US
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Telephone | 559-589-1119
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. JEFFERY LEE HOLSTON
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Credential |
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Telephone | 559-589-1117
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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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