Provider Demographics
NPI:1598409245
Name:JELINI DENTAL CORPORATION
Entity Type:Organization
Organization Name:JELINI DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:FATIMA
Authorized Official - Middle Name:BALA
Authorized Official - Last Name:JELINI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-999-6979
Mailing Address - Street 1:21632 SHERMAN WAY
Mailing Address - Street 2:
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91303-1538
Mailing Address - Country:US
Mailing Address - Phone:818-999-6979
Mailing Address - Fax:818-999-5009
Practice Address - Street 1:21632 SHERMAN WAY
Practice Address - Street 2:
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91303-1538
Practice Address - Country:US
Practice Address - Phone:818-999-6979
Practice Address - Fax:818-999-5009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental