Provider Demographics
NPI:1710296215
Name:NAZARENO, JANICE (DDS)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:
Last Name:NAZARENO
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 1:8163 RIMRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-1133
Mailing Address - Country:US
Mailing Address - Phone:858-549-4946
Mailing Address - Fax:
Practice Address - Street 1:8163 RIMRIDGE LN
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-1133
Practice Address - Country:US
Practice Address - Phone:858-549-4946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-30
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA596911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice