Provider Demographics
NPI:1104682616
Name:DE JESUS, ROMMEL DEXTER MONTEALEGRE (DENTAL HYGIENIST)
Entity type:Individual
Prefix:
First Name:ROMMEL DEXTER
Middle Name:MONTEALEGRE
Last Name:DE JESUS
Suffix:
Gender:M
Credentials:DENTAL HYGIENIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13143 SLEEPY RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-8521
Mailing Address - Country:US
Mailing Address - Phone:818-606-0719
Mailing Address - Fax:
Practice Address - Street 1:13143 SLEEPY RIDGE LN
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-8521
Practice Address - Country:US
Practice Address - Phone:818-606-0719
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-22
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28603124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist