Healthcare Provider Details

I. General information

NPI: 1023298346
Provider Name (Legal Business Name): JARED FINE D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2007
Last Update Date: 03/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 BROADWAY STE 500
OAKLAND CA
94607-4099
US

IV. Provider business mailing address

6991 EXETER DRIVE
OAKLAND CA
94611-4099
US

V. Phone/Fax

Practice location:
  • Phone: 510-208-5911
  • Fax: 510-208-5933
Mailing address:
  • Phone: 510-326-2493
  • Fax: 510-208-5933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number33198
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: