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General NPI Number Information
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NPI Number | 1700938883
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Entity Type | Individual
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Provider Name | JEANNIE T. TE-SAN GABRIEL D.D.S
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Gender | Female
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Dates
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Enumeration Date | 01/17/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 791 E MONTE VISTA AVE # 173
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City | VACAVILLE
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State | CA
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Zip | 95688-2920
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Country | US
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Telephone | 707-359-2122
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Fax |
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Provider Business Mailing Address
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Address Line | 1269 POTRERO CIR
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City | SUISUN CITY
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State | CA
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Zip | 94585-4143
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Country | US
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Telephone | 707-435-0564
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 46986
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License Number State | CA
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