Provider Demographics
NPI:1659616654
Name:KAELEY, JANICE (DDS, MSD)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:
Last Name:KAELEY
Suffix:
Gender:F
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9301 FIRCREST LN STE 5
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-3960
Mailing Address - Country:US
Mailing Address - Phone:925-860-7270
Mailing Address - Fax:
Practice Address - Street 1:9301 FIRCREST LN STE 5
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-3960
Practice Address - Country:US
Practice Address - Phone:925-860-7270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-01
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011365A1223P0300X
CA576581223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics