Provider Demographics
NPI:1609905413
Name:PROVENZANO, NATALIE KRISTINE (DDS)
Entity Type:Individual
Prefix:DR
First Name:NATALIE
Middle Name:KRISTINE
Last Name:PROVENZANO
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 1:6020 HELLYER AVE.
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95138
Mailing Address - Country:US
Mailing Address - Phone:408-226-2542
Mailing Address - Fax:408-226-1948
Practice Address - Street 1:6020 HELLYER AVE.
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95138
Practice Address - Country:US
Practice Address - Phone:408-226-2542
Practice Address - Fax:408-226-1948
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA498691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice