Provider Demographics
NPI:1205989910
Name:ODULIO, JESUS RICARDO (DMD)
Entity type:Individual
Prefix:DR
First Name:JESUS
Middle Name:RICARDO
Last Name:ODULIO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:347 GELLERT BLVD STE K
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-2618
Mailing Address - Country:US
Mailing Address - Phone:650-757-5379
Mailing Address - Fax:650-757-4769
Practice Address - Street 1:347 GELLERT BLVD STE K
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-2618
Practice Address - Country:US
Practice Address - Phone:650-757-5379
Practice Address - Fax:650-757-4769
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA427531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice