Provider Demographics
NPI:1598143208
Name:GEREN, VICTORIA (DDS)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:GEREN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 SHAW AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-4209
Mailing Address - Country:US
Mailing Address - Phone:559-439-9990
Mailing Address - Fax:559-321-8831
Practice Address - Street 1:323 E BULLARD AVE STE 104
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-8620
Practice Address - Country:US
Practice Address - Phone:559-439-9990
Practice Address - Fax:559-439-9996
Is Sole Proprietor?:No
Enumeration Date:2015-05-13
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA644591223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics