Healthcare Provider Details

I. General information

NPI: 1083631709
Provider Name (Legal Business Name): ELLIE JEANETTE ZUIDERVELD DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 10/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 S ASPEN CT STE B
VISALIA CA
93291-5175
US

IV. Provider business mailing address

136 S ASPEN CT STE B
VISALIA CA
93291-5175
US

V. Phone/Fax

Practice location:
  • Phone: 559-625-9300
  • Fax:
Mailing address:
  • Phone: 559-625-9300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number46451
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: