Provider Demographics
NPI:1073097176
Name:KESARIA, JEEL MURJIBHAI
Entity Type:Individual
Prefix:
First Name:JEEL
Middle Name:MURJIBHAI
Last Name:KESARIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:344 E 6TH ST
Mailing Address - Street 2:
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93638-3631
Mailing Address - Country:US
Mailing Address - Phone:559-664-4000
Mailing Address - Fax:559-675-5224
Practice Address - Street 1:344 E 6TH ST
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93638-3631
Practice Address - Country:US
Practice Address - Phone:559-664-4000
Practice Address - Fax:559-675-5224
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-24
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADENT.DE.608779161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice