Provider Demographics
NPI:1992938864
Name:DUNIVAN, JANETTE (DDS)
Entity type:Individual
Prefix:DR
First Name:JANETTE
Middle Name:
Last Name:DUNIVAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:JANETTE
Other - Middle Name:
Other - Last Name:NIEBLAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:6415 GYPSY ROSE CT
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93308-7424
Mailing Address - Country:US
Mailing Address - Phone:323-810-0363
Mailing Address - Fax:
Practice Address - Street 1:380 N. RESERVATION RD.
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257
Practice Address - Country:US
Practice Address - Phone:323-810-0363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-26
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA585981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice