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General NPI Number Information
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NPI Number | 1982067161
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Entity Type | Organization
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Legal Business Name | JANICE KAELEY DDS, A PROFESSIONAL DENTAL CORPORATION
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Dates
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Enumeration Date | 04/04/2016
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Last Update Date | 04/04/2016
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Provider Practice Location Address
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Address Line | 9301 FIRCREST LN SUITE #5
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City | SAN RAMON
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State | CA
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Zip | 94583-3960
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Country | US
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Telephone | 925-557-7115
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Fax |
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Provider Business Mailing Address
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Address Line | 3762 VERONA AVE
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City | TURLOCK
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State | CA
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Zip | 95382-0344
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JANICE KAELEY
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Credential | DDS
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Telephone | 209-648-9896
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 57658
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License Number State | CA
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