Provider Demographics
NPI:1649462540
Name:PATELZICK, JEREMY ALLEN (DDS)
Entity type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:ALLEN
Last Name:PATELZICK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 W VENTURA BLVD STE 165
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-9140
Mailing Address - Country:US
Mailing Address - Phone:805-482-1558
Mailing Address - Fax:805-484-8240
Practice Address - Street 1:400 W VENTURA BLVD STE 165
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-9140
Practice Address - Country:US
Practice Address - Phone:805-482-1558
Practice Address - Fax:805-804-7599
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA561561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB4065422OtherDRIVER'S LICENSE
CA56156OtherDENTAL LICENSE