Provider Demographics
NPI:1518956788
Name:DIMARIANO, JEFF LEWIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFF
Middle Name:LEWIS
Last Name:DIMARIANO
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 1:1610 ARDEN WAY
Mailing Address - Street 2:SUITE 157
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95815-4026
Mailing Address - Country:US
Mailing Address - Phone:916-929-3898
Mailing Address - Fax:916-646-6315
Practice Address - Street 1:1610 ARDEN WAY
Practice Address - Street 2:SUITE 157
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815-4026
Practice Address - Country:US
Practice Address - Phone:916-929-3898
Practice Address - Fax:916-646-6315
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-19
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA298251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice