Provider Demographics
NPI:1376327239
Name:GAENI, ROJEAN
Entity Type:Individual
Prefix:
First Name:ROJEAN
Middle Name:
Last Name:GAENI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2194 OCASO CAMINO
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94539-5646
Mailing Address - Country:US
Mailing Address - Phone:925-667-6381
Mailing Address - Fax:
Practice Address - Street 1:145 E 14TH ST # 100
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-1661
Practice Address - Country:US
Practice Address - Phone:510-587-9400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-22
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA108312122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist