Provider Demographics
NPI:1790971588
Name:JENNINGS-GALDEANO, MARY ELIZABETH (DDS)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ELIZABETH
Last Name:JENNINGS-GALDEANO
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 1:1215 N DEL MAR AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93728-1958
Mailing Address - Country:US
Mailing Address - Phone:559-233-5625
Mailing Address - Fax:559-233-6626
Practice Address - Street 1:1215 N. DEL MAR AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93728-1958
Practice Address - Country:US
Practice Address - Phone:559-233-5625
Practice Address - Fax:559-233-6626
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-14
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56195122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist