Provider Demographics
NPI:1689861320
Name:FANOUS, VENUS (DDS,)
Entity Type:Individual
Prefix:DR
First Name:VENUS
Middle Name:
Last Name:FANOUS
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 1:11704 VALLEY FORGE WAY
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93312-8288
Mailing Address - Country:US
Mailing Address - Phone:661-900-8442
Mailing Address - Fax:
Practice Address - Street 1:900 QUEBEC AVE.
Practice Address - Street 2:
Practice Address - City:CORCORAN
Practice Address - State:CA
Practice Address - Zip Code:93212-7100
Practice Address - Country:US
Practice Address - Phone:559-992-7100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-26
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53319122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist