Provider Demographics
NPI:1164032074
Name:BAYRAKDARIAN CLOVIS II, D.M.D., INC., A CALIFORNIA PROFESSIONAL DENTAL
Entity Type:Organization
Organization Name:BAYRAKDARIAN CLOVIS II, D.M.D., INC., A CALIFORNIA PROFESSIONAL DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BURUCA
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:559-837-1066
Mailing Address - Street 1:427 W NEES AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-4434
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:427 W NEES AVE STE 101
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-4434
Practice Address - Country:US
Practice Address - Phone:559-297-2121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-05
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Multi-Specialty