Healthcare Provider Details

I. General information

NPI: 1659623973
Provider Name (Legal Business Name): JENNIFER ELMER DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2012
Last Update Date: 10/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30979 ROAD 67
VISALIA CA
93291-9303
US

IV. Provider business mailing address

30979 ROAD 67
VISALIA CA
93291-9303
US

V. Phone/Fax

Practice location:
  • Phone: 559-651-2301
  • Fax: 559-651-1584
Mailing address:
  • Phone: 559-651-2301
  • Fax: 559-651-1584

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number61654
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: