Provider Demographics
NPI:1598846230
Name:MORENO, JANICE GALE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JANICE
Middle Name:GALE
Last Name:MORENO
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 1:3427 DEER PARK DR
Mailing Address - Street 2:SUITE #C
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95219-2355
Mailing Address - Country:US
Mailing Address - Phone:209-478-3036
Mailing Address - Fax:209-478-0258
Practice Address - Street 1:3427 DEER PARK DR
Practice Address - Street 2:SUITE #C
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95219-2355
Practice Address - Country:US
Practice Address - Phone:209-478-3036
Practice Address - Fax:209-478-0258
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34387122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist