Provider Demographics
NPI:1649280686
Name:IRASUSTA, CATHERINE (DMD)
Entity type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:
Last Name:IRASUSTA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1575 W SHAW AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-3503
Mailing Address - Country:US
Mailing Address - Phone:559-221-7303
Mailing Address - Fax:559-221-7352
Practice Address - Street 1:1575 W SHAW AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-3503
Practice Address - Country:US
Practice Address - Phone:559-221-7303
Practice Address - Fax:559-221-7352
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA472561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice