Healthcare Provider Details

I. General information

NPI: 1174354955
Provider Name (Legal Business Name): HELIA JAFARI DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2024
Last Update Date: 08/12/2024
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6543 E SPRING ST UNIT A6
LONG BEACH CA
90808-4023
US

IV. Provider business mailing address

6543 E SPRING ST UNIT A6
LONG BEACH CA
90808-4023
US

V. Phone/Fax

Practice location:
  • Phone: 562-472-0447
  • Fax:
Mailing address:
  • Phone: 562-472-0447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. HELIA JAFARI
Title or Position: ORTHODONTIST
Credential: DDS
Phone: 562-472-0447