Provider Demographics
NPI:1326211871
Name:DE JESUS, ROLANDO ALGOZO (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROLANDO
Middle Name:ALGOZO
Last Name:DE JESUS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 W ROBINHOOD DR
Mailing Address - Street 2:SUITE #4
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-5512
Mailing Address - Country:US
Mailing Address - Phone:209-451-3155
Mailing Address - Fax:209-451-3154
Practice Address - Street 1:1350 W. ROBINHOOD DR.
Practice Address - Street 2:SUITE #4
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-5512
Practice Address - Country:US
Practice Address - Phone:510-676-4897
Practice Address - Fax:209-451-3154
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-04
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA413881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
41388OtherDENTAL BOARD OF CALIFORNI