Provider Demographics
NPI:1669087623
Name:MEZA PRIETO, EDUARDO (DMD)
Entity type:Individual
Prefix:DR
First Name:EDUARDO
Middle Name:
Last Name:MEZA PRIETO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5372 E FLORENCE AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-5282
Mailing Address - Country:US
Mailing Address - Phone:559-960-1759
Mailing Address - Fax:
Practice Address - Street 1:1315 SHAW AVE STE 102
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-3963
Practice Address - Country:US
Practice Address - Phone:559-321-0886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-15
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1055361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice