Provider Demographics
NPI:1093069809
Name:PATINO, JESUS ISAAC JR (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:JESUS
Middle Name:ISAAC
Last Name:PATINO
Suffix:JR
Gender:M
Credentials:DDS, MS
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Mailing Address - Street 1:9301 FIRCREST LN STE 1
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-3960
Mailing Address - Country:US
Mailing Address - Phone:925-828-6972
Mailing Address - Fax:925-828-6996
Practice Address - Street 1:9301 FIRCREST LN STE 1
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-3960
Practice Address - Country:US
Practice Address - Phone:925-828-6972
Practice Address - Fax:925-828-6996
Is Sole Proprietor?:No
Enumeration Date:2012-10-31
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
CA623811223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program