Organization
DEMETRIO STA ANA JR DDS INC
Active
Parent organization
DEMETRIO STA ANA JR DDS INC
Other names
Shaw Family Dental
Organization subpart
Yes
Provider details
NPI number
Legal business name
DEMETRIO STA ANA JR DDS INC
Authorized official
DR. DEMETRIO TAGULINAO STA. ANA JR. DDS (PRESIDENT)
(559) 277-0111
Entity
Organization
Contact information
Practice address
3616 W SHAW AVE, FRESNO, CA 93711-3231
(559) 277-0111
Mailing address
3616 W. SHAW AVENUE, FRESNO, CA 93711
(559) 277-0111
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
43250
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
43250
DENTAL LICENSE
CA
Enumeration date
11/03/2007
Last updated
03/07/2023
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