Provider Demographics
NPI:1396355301
Name:JAMAL ALDEEN, RANIYA IBRAHIM A (DMD, MS)
Entity type:Individual
Prefix:DR
First Name:RANIYA
Middle Name:IBRAHIM A
Last Name:JAMAL ALDEEN
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7950 ETIWANDA AVE APT 8207
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91739-8711
Mailing Address - Country:US
Mailing Address - Phone:813-765-7771
Mailing Address - Fax:
Practice Address - Street 1:7950 ETIWANDA AVE APT 8207
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91739-8711
Practice Address - Country:US
Practice Address - Phone:813-765-7771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-04
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA105200122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist