Provider Demographics
NPI:1669598975
Name:MID VALLEY DENTAL CARE
Entity type:Organization
Organization Name:MID VALLEY DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:REY
Authorized Official - Middle Name:QUIJANO
Authorized Official - Last Name:YULIONGSIU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:559-228-9300
Mailing Address - Street 1:4035 N FRESNO ST STE 105
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93726-4041
Mailing Address - Country:US
Mailing Address - Phone:559-228-9300
Mailing Address - Fax:559-228-9302
Practice Address - Street 1:4035 N FRESNO ST STE 105
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-4041
Practice Address - Country:US
Practice Address - Phone:559-228-9300
Practice Address - Fax:559-228-9302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA461581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty