Healthcare Provider Details

I. General information

NPI: 1376103077
Provider Name (Legal Business Name): LANA JABAJI DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2019
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 W MORTON AVE
PORTERVILLE CA
93257-2331
US

IV. Provider business mailing address

PO BOX 262
PORTERVILLE CA
93258-0262
US

V. Phone/Fax

Practice location:
  • Phone: 559-210-9098
  • Fax:
Mailing address:
  • Phone: 716-579-3269
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number105521
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: