Provider Demographics
NPI:1326166984
Name:NORDEEN, JEANINE ELIZABETH (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEANINE
Middle Name:ELIZABETH
Last Name:NORDEEN
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:PO BOX 22
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-0722
Mailing Address - Country:US
Mailing Address - Phone:707-927-8085
Mailing Address - Fax:
Practice Address - Street 1:1701 ROCKVILLE RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534-1473
Practice Address - Country:US
Practice Address - Phone:707-759-4639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2011-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34179122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist