Provider Demographics
NPI:1073862918
Name:DR. RICK JELMINI, A PROFESSIONAL CORP
Entity Type:Organization
Organization Name:DR. RICK JELMINI, A PROFESSIONAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:JELMINI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:559-439-2147
Mailing Address - Street 1:7104 N FRESNO ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-2970
Mailing Address - Country:US
Mailing Address - Phone:559-439-2147
Mailing Address - Fax:559-439-1703
Practice Address - Street 1:7104 N FRESNO ST
Practice Address - Street 2:SUITE 101
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2970
Practice Address - Country:US
Practice Address - Phone:559-439-2147
Practice Address - Fax:559-439-1703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-06
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA298111223P0221X
CA613091223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty