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6495 N. Palm Ave St #105 Fresno CA 93704 | |
| (559) 277-3001 | |
| (559) 277-3031 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 6495 N. Palm Ave St #105, Fresno, California |
| Authorized Official Name and Position | Mark Leonard Davis (OWNER - DENTIST) |
| Authorized Official Contact | 5592773001 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
6495 N. Palm Ave St #105 Fresno CA 93704 Ph: (559) 277-3001 | 6495 N. Palm Ave St #105 Fresno CA 93704 Ph: (559) 277-3001 |
| NPI Number | 1598259459 |
|---|---|
| Provider Enumeration Date | 06/14/2018 |
| Last Update Date | 12/29/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598259459 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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