Healthcare Provider Details

I. General information

NPI: 1861589657
Provider Name (Legal Business Name): JEFFREY MICHAEL JAVELET DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7855 FAY AVENUE SUITE 210
LA JOLLA CA
92037
US

IV. Provider business mailing address

7855 FAY AVE SUITE 210
LA JOLLA CA
92037-4265
US

V. Phone/Fax

Practice location:
  • Phone: 858-454-0366
  • Fax: 858-454-8786
Mailing address:
  • Phone: 858-454-0366
  • Fax: 858-454-8786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number29309
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: