Provider Demographics
NPI:1467642710
Name:CANTER, JELENA (RDHAP, BS)
Entity Type:Individual
Prefix:
First Name:JELENA
Middle Name:
Last Name:CANTER
Suffix:
Gender:F
Credentials:RDHAP, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1514 CRESTMONT AVE
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-5743
Mailing Address - Country:US
Mailing Address - Phone:916-676-3086
Mailing Address - Fax:
Practice Address - Street 1:1514 CRESTMONT AVE
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-5743
Practice Address - Country:US
Practice Address - Phone:916-676-3086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-01
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA178124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist