Provider Demographics
NPI:1689773145
Name:NERI, DORENE (DDS)
Entity Type:Individual
Prefix:DR
First Name:DORENE
Middle Name:
Last Name:NERI
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 A
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95219-2355
Mailing Address - Country:US
Mailing Address - Phone:209-478-2252
Mailing Address - Fax:209-478-1231
Practice Address - Street 1:3427 DEER PARK DR
Practice Address - Street 2:SUITE A
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95219-2355
Practice Address - Country:US
Practice Address - Phone:209-478-2252
Practice Address - Fax:209-478-1231
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA429381223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics