Provider Demographics
NPI:1982067161
Name:JANICE KAELEY DDS, A PROFESSIONAL DENTAL CORPORATION
Entity type:Organization
Organization Name:JANICE KAELEY DDS, A PROFESSIONAL DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:
Authorized Official - Last Name:KAELEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:209-648-9896
Mailing Address - Street 1:3762 VERONA AVE
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95382-0344
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9301 FIRCREST LN
Practice Address - Street 2:SUITE #5
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-3960
Practice Address - Country:US
Practice Address - Phone:925-557-7115
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-04
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA576581223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty