Provider Demographics
NPI:1538233556
Name:JAWALE, RESHMA R (DDS)
Entity type:Individual
Prefix:
First Name:RESHMA
Middle Name:R
Last Name:JAWALE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1477 FITZGERALD DR
Mailing Address - Street 2:SUITE 106
Mailing Address - City:PINOLE
Mailing Address - State:CA
Mailing Address - Zip Code:94564-2257
Mailing Address - Country:US
Mailing Address - Phone:510-669-0350
Mailing Address - Fax:
Practice Address - Street 1:1477 FITZGERALD DR
Practice Address - Street 2:SUITE 106
Practice Address - City:PINOLE
Practice Address - State:CA
Practice Address - Zip Code:94564-2257
Practice Address - Country:US
Practice Address - Phone:510-669-0350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA542671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice