Individual
BERNARD LAGELLE JETER SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
805 W. ACEQUIA AVE, #2B, VISALIA, CA 93291
(559) 739-8400
(559) 739-8333
Mailing address
805 W. ACEQUIA AVE, #2B, VISALIA, CA 93291
(559) 739-8400
(559) 739-8333
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
13691
CA
1223G0001X
General Practice Dentistry
Primary
23523
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
862543
UNITED CONCORDIA
CA
01
—
B 23523 01
DENTICAL
CA
Enumeration date
02/20/2007
Last updated
10/06/2009
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