Provider Demographics
NPI:1902909054
Name:PORTALES, RAMON JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:RAMON
Middle Name:
Last Name:PORTALES
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7467 N CEDAR AVE
Mailing Address - Street 2:PMB #9
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3637
Mailing Address - Country:US
Mailing Address - Phone:559-281-3172
Mailing Address - Fax:
Practice Address - Street 1:407 S CLOVIS AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93727-4284
Practice Address - Country:US
Practice Address - Phone:559-255-3333
Practice Address - Fax:559-255-7271
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34194122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist