Provider Demographics
NPI:1629494968
Name:VISALIA DENTISTRY 4 KIDS
Entity Type:Organization
Organization Name:VISALIA DENTISTRY 4 KIDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:T
Authorized Official - Last Name:CANADA
Authorized Official - Suffix:
Authorized Official - Credentials:DDSMS
Authorized Official - Phone:559-733-4470
Mailing Address - Street 1:3912 W CALDWELL AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-9249
Mailing Address - Country:US
Mailing Address - Phone:559-733-4470
Mailing Address - Fax:559-733-0817
Practice Address - Street 1:3912 W CALDWELL AVE
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-9249
Practice Address - Country:US
Practice Address - Phone:559-733-4470
Practice Address - Fax:559-733-0817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-11
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA388121223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty