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Organization
MARK W. STAGIS DDS, NATHAN E. VICK DDS DENTAL GROUP
Active
Organization
MARK W. STAGIS DDS, NATHAN E. VICK DDS DENTAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK STAGIS DDS (DENTIST)
(559) 439-1245
Entity
Organization
Contact information
Practice address
6215 N FRESNO ST, SUITE 101, FRESNO, CA 93710-5267
(559) 439-1245
(559) 439-0312
Mailing address
6215 N FRESNO ST, SUITE 101, FRESNO, CA 93710-5267
(559) 439-1245
(559) 439-0312
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
28987
CA
1223G0001X
General Practice Dentistry
54793
CA
1223G0001X
General Practice Dentistry
59735
CA
Other
Enumeration date
12/14/2010
Last updated
12/14/2010
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