Provider Demographics
NPI:1235673773
Name:FRESNO DENTAL SURGERY CENTER LLC
Entity Type:Organization
Organization Name:FRESNO DENTAL SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, CEO & SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:FIGUEROA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-968-8729
Mailing Address - Street 1:2828 FRESNO ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93721-1327
Mailing Address - Country:US
Mailing Address - Phone:559-263-9648
Mailing Address - Fax:559-263-9777
Practice Address - Street 1:2828 FRESNO ST
Practice Address - Street 2:SUITE 100
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93721-1327
Practice Address - Country:US
Practice Address - Phone:559-263-9648
Practice Address - Fax:559-263-9777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-16
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical