MEDICARE: DR. MARIA GABRIELA ECHAVERRY-CENTENO DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	56580	CA

General Provider Information

NPI Number	:	1396925921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIA GABRIELA ECHAVERRY-CENTENO DDS

Provider Business Mailing Address
First Line	:	PO BOX 6230
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93703-6230
Country	:	US
Telephone Number	:	559-974-6392
Fax Number	:

Provider Business Practice Location Address
First Line	:	2841 TULARE ST
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93721-1320
Country	:	US
Telephone Number	:	559-222-2238
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/12/2007
Last Update Date	:	10/04/2014

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