Healthcare Provider Details

I. General information

NPI: 1326931437
Provider Name (Legal Business Name): JERRY ALONZA JARRETT JR. DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2025
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MERCY CIR
CAMP PENDLETON CA
92055-5191
US

IV. Provider business mailing address

1129 CHIPPING CT
VIRGINIA BEACH VA
23455-6803
US

V. Phone/Fax

Practice location:
  • Phone: 760-725-1288
  • Fax:
Mailing address:
  • Phone: 757-831-8404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number1
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: