Provider Demographics
NPI:1124271937
Name:FRISANCHO, MIGUEL A (DDS)
Entity type:Individual
Prefix:MR
First Name:MIGUEL
Middle Name:A
Last Name:FRISANCHO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 RIVERVIEW DR APT 268
Mailing Address - Street 2:
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93637-2789
Mailing Address - Country:US
Mailing Address - Phone:559-975-7474
Mailing Address - Fax:
Practice Address - Street 1:2300 RIVERVIEW DR APT 268
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93637-2789
Practice Address - Country:US
Practice Address - Phone:559-975-7474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-24
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57851122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist