Provider Demographics
NPI:1154466027
Name:DONESA, ARLYN HEIDI (DDS)
Entity Type:Individual
Prefix:
First Name:ARLYN
Middle Name:HEIDI
Last Name:DONESA
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 1:1130 N EL DORADO ST
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95202-1332
Mailing Address - Country:US
Mailing Address - Phone:209-939-1100
Mailing Address - Fax:209-939-1300
Practice Address - Street 1:1130 N EL DORADO ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95202-1332
Practice Address - Country:US
Practice Address - Phone:209-939-1100
Practice Address - Fax:209-939-1300
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA502391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice