Provider Demographics
NPI:1003102443
Name:CALIFORNIA KIDDS PEDIATRIC DENTISTRY
Entity Type:Organization
Organization Name:CALIFORNIA KIDDS PEDIATRIC DENTISTRY
Other - Org Name:JEFFREY EVANS DDS & JEFFREY KUNKEL DDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:B
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:559-439-6600
Mailing Address - Street 1:7525 N. CEDAR AVE
Mailing Address - Street 2:#105
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720
Mailing Address - Country:US
Mailing Address - Phone:559-439-6600
Mailing Address - Fax:559-439-5400
Practice Address - Street 1:7525 N. CEDAR AVE
Practice Address - Street 2:#105
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720
Practice Address - Country:US
Practice Address - Phone:559-439-6600
Practice Address - Fax:559-439-5400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-23
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA595121223P0221X
CA600831223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty