Provider Demographics
NPI:1891110870
Name:NELSON, JANINE (RDH)
Entity Type:Individual
Prefix:
First Name:JANINE
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3885 BEACON AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1462
Mailing Address - Country:US
Mailing Address - Phone:510-745-1800
Mailing Address - Fax:
Practice Address - Street 1:3885 BEACON AVE
Practice Address - Street 2:SUITE C
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1462
Practice Address - Country:US
Practice Address - Phone:510-745-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-27
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26116124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA26116OtherDHCC