Provider Demographics
NPI:1427490531
Name:JACK OHANESIAN DDS INC
Entity type:Organization
Organization Name:JACK OHANESIAN DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:OHANESIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:559-229-3541
Mailing Address - Street 1:3727 N 1ST ST STE 102
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93726-5628
Mailing Address - Country:US
Mailing Address - Phone:559-229-3541
Mailing Address - Fax:559-229-2421
Practice Address - Street 1:3727 N 1ST ST STE 102
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-5628
Practice Address - Country:US
Practice Address - Phone:559-229-3541
Practice Address - Fax:559-229-2421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-18
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty