Provider Demographics
NPI:1386198166
Name:ANTOLINEZ KAI, VANESSA (DDS)
Entity Type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:
Last Name:ANTOLINEZ KAI
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 1:703 N ABALONE DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-0011
Mailing Address - Country:US
Mailing Address - Phone:929-319-5322
Mailing Address - Fax:
Practice Address - Street 1:2405 GEM AVE
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:CA
Practice Address - Zip Code:94587-5213
Practice Address - Country:US
Practice Address - Phone:408-571-9502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-09
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0105221223P0221X
CA1006351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No1223P0221XDental ProvidersDentistPediatric Dentistry