|
| |
|
3616 W Shaw Ave Fresno CA 93711-3231 | |
| (559) 277-0111 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 3616 W Shaw Ave, Fresno, California |
| Authorized Official Name and Position | Demetrio Tagulinao Sta. Ana (PRESIDENT) |
| Authorized Official Contact | 5592770111 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
3616 W. Shaw Avenue Fresno CA 93711 Ph: (559) 277-0111 | 3616 W Shaw Ave Fresno CA 93711-3231 Ph: (559) 277-0111 |
| NPI Number | 1952581282 |
|---|---|
| Provider Enumeration Date | 11/03/2007 |
| Last Update Date | 03/07/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952581282 | NPI | - | NPPES |
| 43250 | Other | CA | DENTAL LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 43250 (California) | Primary |
Raji Haddad D.d.s. Inc. Dba First Family Dental Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 310 W Shaw Ave, Fresno, CA 93704 Phone: 559-229-8200 | |
Kamal Dental Inc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 6319 N Fresno St Ste 101, Fresno, CA 93710 Phone: 559-438-6177 |