Organization
VALLARINE DENTAL, LLC
Active
Other names
Fresno Dental Surgery Center, a Vallarine Dental Practice
Organization subpart
No
Provider details
NPI number
Authorized official
DEVIN LARSEN (CEO)
(713) 489-2198
Entity
Organization
Contact information
Practice address
2828 FRESNO ST, SUITE 100, FRESNO, CA 93721-1327
(559) 263-9648
(559) 263-9777
Mailing address
9709 LAKESIDE BLVD STE 350, SPRING, TX 77381-1216
(713) 489-2198
(713) 489-2978
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
550000219
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05C001770
CMS
CA
01
—
AS1770
BLUE CROSS
CA
05
—
G9397701
—
CA
01
—
G9862301
HEALTHY FAMILIES
CA
05
—
SURO1770F
—
CA
05
—
ZZZ019572
—
CA
Enumeration date
09/14/2006
Last updated
05/01/2026
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