# DEMETRIO STA ANA JR DDS INC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** DEMETRIO STA ANA JR DDS INC
- **Other names:** Shaw Family Dental
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1952581282
- **Legal business name:** DEMETRIO STA ANA JR DDS INC
- **Authorized official:** DR. DEMETRIO TAGULINAO STA. ANA JR. DDS (PRESIDENT)
- **Authorized official phone:** (559) 277-0111

## Contact information

- **Practice address:** 3616 W SHAW AVE, FRESNO, CA 93711-3231
- **Practice address phone:** (559) 277-0111
- **Mailing address:** 3616 W. SHAW AVENUE, FRESNO, CA 93711
- **Mailing address phone:** (559) 277-0111

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 43250 | CA | Yes |

## Other

- **Enumeration date:** 11/03/2007
- **Last updated:** 03/07/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 43250 | DENTAL LICENSE | CA |