Healthcare Provider Details

I. General information

NPI: 1013786045
Provider Name (Legal Business Name): JEQUINTO DENTAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2024
Last Update Date: 01/04/2024
Certification Date: 01/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7801 CENTER AVE STE 101
HUNTINGTON BEACH CA
92647-9112
US

IV. Provider business mailing address

7801 CENTER AVE STE 101
HUNTINGTON BEACH CA
92647-9112
US

V. Phone/Fax

Practice location:
  • Phone: 210-568-9800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVE GOLDWYN JEQUINTO
Title or Position: OWNER DDS
Credential:
Phone: 210-568-9800