Provider Demographics
NPI:1851000400
Name:O'HARA PRIETO EVANS KUNKEL DENTAL, INC.
Entity Type:Organization
Organization Name:O'HARA PRIETO EVANS KUNKEL DENTAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:559-367-9459
Mailing Address - Street 1:7025 N MAPLE AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-8006
Mailing Address - Country:US
Mailing Address - Phone:559-439-6600
Mailing Address - Fax:
Practice Address - Street 1:7025 N MAPLE AVE STE 101
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-8006
Practice Address - Country:US
Practice Address - Phone:559-439-6600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-22
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty