Provider Demographics
NPI:1619131067
Name:MARNENI, NIRMALA JYOTHI (DDS)
Entity Type:Individual
Prefix:
First Name:NIRMALA JYOTHI
Middle Name:
Last Name:MARNENI
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 1:200 W CENTRAL AVE
Mailing Address - Street 2:APT# 3616
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376-8190
Mailing Address - Country:US
Mailing Address - Phone:408-338-7299
Mailing Address - Fax:
Practice Address - Street 1:2605 COFFEE RD
Practice Address - Street 2:#200
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-2007
Practice Address - Country:US
Practice Address - Phone:209-521-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-15
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57122122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist