NPIMap

Organization Active NPI

Willow Dental Group

  • Dentist
  • Fresno, CA
National Provider Identifier
1043610165
Registry record updated Aug 26, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
WILLOW DENTAL GROUP
Practice address
6753 N Willow Ave
Fresno, CA 93710-5900
Phone
(559) 434-1088
NPI assigned
Aug 26, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 26, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Shawn E Anderson, DDSNPI 1285852673
Title
Owner
Phone
(559) 434-1088

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X Primary

Addresses

Primary practice location

6753 N Willow Ave
Fresno, CA 93710-5900

Mailing address

6753 N Willow Ave
Fresno, CA 93710-5900
Phone (559) 434-1088

National Provider Directory

National Provider Directory

Locations

6753 N Willow Ave
Fresno, CA 93710
Phone (559) 424-1088

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1409011200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1409011200000",
    "number": "1043610165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6753 N WILLOW AVE",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937105900",
            "telephone_number": "559-434-1088"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6753 N WILLOW AVE",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937105900",
            "telephone_number": "559-434-1088"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLOW DENTAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-26",
        "last_updated": "2014-08-26",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "SHAWN",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "559-434-1088",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fresno, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.