Healthcare Provider Details

I. General information

NPI: 1871614818
Provider Name (Legal Business Name): JENIFER B LABRADOR DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 06/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22211 S AVALON BLVD
CARSON CA
90745
US

IV. Provider business mailing address

22211 S AVALON BLVD
CARSON CA
90745
US

V. Phone/Fax

Practice location:
  • Phone: 310-835-9010
  • Fax: 310-835-3044
Mailing address:
  • Phone: 310-835-9010
  • Fax: 310-835-3044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number42840
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number42840
License Number StateCA

VIII. Authorized Official

Name: DR. JENIFER B LABRADOR
Title or Position: DENTIST OWNER
Credential: DDS
Phone: 310-835-9010