Healthcare Provider Details

I. General information

NPI: 1962562074
Provider Name (Legal Business Name): DENISE A ZENDEJAS DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9150 CAMPO ROAD
SPRING VALLEY CA
91977
US

IV. Provider business mailing address

9150 CAMPO ROAD
SPRING VALLEY CA
91977
US

V. Phone/Fax

Practice location:
  • Phone: 619-469-3993
  • Fax: 619-469-3992
Mailing address:
  • Phone: 619-469-3993
  • Fax: 619-469-3992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number45635
License Number StateCA

VIII. Authorized Official

Name: DR. DENISE A ZENDEJAS
Title or Position: DENTIST PRESIDENT
Credential: DDS
Phone: 619-469-3993