Provider Demographics
NPI:1275916348
Name:JELINI, FATIMA BALA (DDS)
Entity Type:Individual
Prefix:DR
First Name:FATIMA
Middle Name:BALA
Last Name:JELINI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:FATEMEH
Other - Middle Name:
Other - Last Name:BALAJELINI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:21632 SHERMAN WAY
Mailing Address - Street 2:
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91303-1538
Mailing Address - Country:US
Mailing Address - Phone:818-999-6979
Mailing Address - Fax:818-999-5009
Practice Address - Street 1:21632 SHERMAN WAY
Practice Address - Street 2:
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91303-1538
Practice Address - Country:US
Practice Address - Phone:818-999-6979
Practice Address - Fax:818-999-5009
Is Sole Proprietor?:No
Enumeration Date:2015-07-07
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31158122300000X
CA100488122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist