Provider Demographics
NPI:1154199404
Name:CENTRAL VALLEY DENTAL IMPLANT & ORAL SURGERY INSTITUTE II
Entity type:Organization
Organization Name:CENTRAL VALLEY DENTAL IMPLANT & ORAL SURGERY INSTITUTE II
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SPENCER
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:559-732-7946
Mailing Address - Street 1:PO BOX 7239
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93290-7239
Mailing Address - Country:US
Mailing Address - Phone:559-732-7946
Mailing Address - Fax:559-732-9621
Practice Address - Street 1:1116 N CHINOWTH ST
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-7896
Practice Address - Country:US
Practice Address - Phone:559-732-7946
Practice Address - Fax:559-732-9621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-15
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty