Provider Demographics
NPI:1093367054
Name:I J BAYRAKDARIAN DMD A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:I J BAYRAKDARIAN DMD A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BURUCA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-222-2522
Mailing Address - Street 1:1616 W SHAW AVE STE A6
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-3513
Mailing Address - Country:US
Mailing Address - Phone:559-222-2522
Mailing Address - Fax:559-222-3022
Practice Address - Street 1:1479 W LACEY BLVD
Practice Address - Street 2:
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-5906
Practice Address - Country:US
Practice Address - Phone:559-222-2522
Practice Address - Fax:559-222-3022
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:I. J. BAYRAKDARIAN DMD A PROFESSIONAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-07-10
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty