Provider Demographics
NPI:1467151308
Name:RALDIRIS, JESSICA VENTENILLA (DMD, MPH)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:VENTENILLA
Last Name:RALDIRIS
Suffix:
Gender:F
Credentials:DMD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:825 N GRAND AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:NOGALES
Mailing Address - State:AZ
Mailing Address - Zip Code:85621-1061
Mailing Address - Country:US
Mailing Address - Phone:520-375-5032
Mailing Address - Fax:520-761-2159
Practice Address - Street 1:6422 E SPEEDWAY BLVD STE 150
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-1149
Practice Address - Country:US
Practice Address - Phone:520-326-8516
Practice Address - Fax:520-326-8516
Is Sole Proprietor?:No
Enumeration Date:2023-02-28
Last Update Date:2025-07-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZD012432122300000X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist