Healthcare Provider Details

I. General information

NPI: 1699854935
Provider Name (Legal Business Name): JAVIER REINALDO BUENDIA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2521 EAST FLORENCE AVE SUITE B2
HUNTINGTON PARK CA
90255
US

IV. Provider business mailing address

2521 EAST FLORENCE AVE SUITE B2
HUNTINGTON PARK CA
90255
US

V. Phone/Fax

Practice location:
  • Phone: 323-582-4600
  • Fax: 323-582-4611
Mailing address:
  • Phone: 323-582-4600
  • Fax: 323-582-4611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number44839
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: