Organization
POWELL PEDIATRIC DENTISTRY INGRAM PARTNERSHIP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRENT DAVID POWELL DMD (MANAGING PARTNER)
(559) 321-1833
Entity
Organization
Contact information
Practice address
7761 N INGRAM AVE, SUITE 101, FRESNO, CA 93711
(559) 431-9701
Mailing address
7761 N INGRAM AVE, SUITE #101, FRESNO, CA 93711
(559) 431-9701
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Enumeration date
07/24/2017
Last updated
07/24/2017
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