Provider Demographics
NPI:1699052886
Name:DOWNTOWN DENTAL SURGERY CENTER OF FRESNO
Entity type:Organization
Organization Name:DOWNTOWN DENTAL SURGERY CENTER OF FRESNO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SHELBY
Authorized Official - Middle Name:
Authorized Official - Last Name:JOBE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-212-2123
Mailing Address - Street 1:2838 MARIPOSA ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93721-1308
Mailing Address - Country:US
Mailing Address - Phone:831-212-2123
Mailing Address - Fax:888-630-8881
Practice Address - Street 1:1045 S ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93721-1406
Practice Address - Country:US
Practice Address - Phone:559-266-2005
Practice Address - Fax:888-630-8881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-16
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical