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3920 N Cedar Ave Fresno CA 93726-5270 | |
(323) 461-9942 | |
Not Available |
Full Name | |
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Speciality | Dentist |
Location | 3920 N Cedar Ave, Fresno, California |
Authorized Official Name and Position | Jerry L Lanier (PREDIDENT/CEO) |
Authorized Official Contact | 3234619942 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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4905 Hollywood Blvd Los Angeles CA 90027-6101 Ph: () - | 3920 N Cedar Ave Fresno CA 93726-5270 Ph: (323) 461-9942 |
NPI Number | 1922416155 |
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Provider Enumeration Date | 07/31/2014 |
Last Update Date | 07/31/2014 |
Identifier | Type | State | Issuer |
---|---|---|---|
1922416155 | NPI | - | NPPES |
1356489660 | Medicaid | CA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
122300000X | Dentist | (* (Not Available)) | Primary |
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