Healthcare Provider Details

I. General information

NPI: 1700145273
Provider Name (Legal Business Name): JARED R. GIANQUINTO, DMD, MS, INC A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2012
Last Update Date: 11/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 CALLOWAY DR SUITE 206
BAKERSFIELD CA
93312-2826
US

IV. Provider business mailing address

1400 CALLOWAY DR SUITE 206
BAKERSFIELD CA
93312-2826
US

V. Phone/Fax

Practice location:
  • Phone: 661-215-4995
  • Fax: 888-527-3506
Mailing address:
  • Phone: 661-215-4995
  • Fax: 888-527-3506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number54756
License Number StateCA

VIII. Authorized Official

Name: DR. JARED ROBERT GIANQUINTO
Title or Position: OWNER
Credential: DMD, MS
Phone: 661-215-4995