Provider Demographics
NPI:1164092292
Name:BELARDINELLI, MARISSA NICOLE SALDANA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARISSA
Middle Name:NICOLE SALDANA
Last Name:BELARDINELLI
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 1:3454 DEL DIOS AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93619-7247
Mailing Address - Country:US
Mailing Address - Phone:559-274-5189
Mailing Address - Fax:
Practice Address - Street 1:2747 W BULLARD AVE STE 103
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-2279
Practice Address - Country:US
Practice Address - Phone:559-436-8288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-30
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1063691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice