Organization
POWELL PEDIATRIC DENTISTRY CHESTNUT PARTNERSHIP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRENT D POWELL DMD (MANAGING MEMBER)
(559) 299-3949
Entity
Organization
Contact information
Practice address
7005 N. CHESTNUT AVE STE 101, FRESNO, CA 93720
(559) 299-5949
(559) 299-7880
Mailing address
7005 N. CHESTNUT AVE STE. 101, FRESNO, CA 93720
(559) 299-5949
(559) 299-7880
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
101165
CA
1223P0221X
Pediatric Dentistry
Primary
56148
CA
Other
Enumeration date
07/25/2018
Last updated
07/25/2018
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