Provider Demographics
NPI:1770181851
Name:BAYRAKDARIAN MADERA, D.M.D., INC., A PROFESSIONAL DENTAL CORPORATION
Entity Type:Organization
Organization Name:BAYRAKDARIAN MADERA, D.M.D., INC., A PROFESSIONAL DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ISHKHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BAYRAKDARIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:559-341-0490
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 1:2377 W CLEVELAND AVE STE 101
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93637-8754
Practice Address - Country:US
Practice Address - Phone:559-660-5588
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-12
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental