Provider Demographics
NPI:1083631709
Name:ZUIDERVELD, ELLIE JEANETTE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELLIE
Middle Name:JEANETTE
Last Name:ZUIDERVELD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 S ASPEN CT STE B
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-5175
Mailing Address - Country:US
Mailing Address - Phone:559-625-9300
Mailing Address - Fax:
Practice Address - Street 1:136 S ASPEN CT STE B
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-5175
Practice Address - Country:US
Practice Address - Phone:559-625-9300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46451122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist