Provider Demographics
NPI:1487737029
Name:PALENCIA, GLORIA ELIZABETH (DDS)
Entity type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:ELIZABETH
Last Name:PALENCIA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:PALENCIA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3039 W FAIRMONT AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93722-4018
Mailing Address - Country:US
Mailing Address - Phone:559-546-3429
Mailing Address - Fax:
Practice Address - Street 1:2735 N BLACKSTONE AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93703-1705
Practice Address - Country:US
Practice Address - Phone:559-225-3391
Practice Address - Fax:559-225-1601
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA425921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice