Basic Information
| Provider Information | |||||||||
| NPI: | 1437814803 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | OZDER DENTAL CORPORATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1530 E GOLDEN VALLEY WAY | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937303587 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5594750357 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1010 SHAW AVE STE B | ||||||||
| Address2: | |||||||||
| City: | CLOVIS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 936123950 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5593231776 | ||||||||
| FaxNumber: | 5593234301 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2021 | ||||||||
| LastUpdateDate: | 11/01/2021 | ||||||||
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| AuthorizedOfficialLastName: | OZDER | ||||||||
| AuthorizedOfficialFirstName: | NECDET | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 5592551122 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DDS | ||||||||
| NPICertificationDate: | 11/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QD0000X | Y | Ambulatory Health Care Facilities | Clinic/Center | Dental |
No ID Information.