Provider Demographics
NPI:1760272579
Name:CARRANCO DMD INC
Entity type:Organization
Organization Name:CARRANCO DMD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PEDIATRIC DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRANCO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:909-973-2773
Mailing Address - Street 1:498 W SERENA AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93619-0431
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:615 BARSTOW AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-2230
Practice Address - Country:US
Practice Address - Phone:909-973-2773
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARRANCO DMD INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-05-07
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty