Healthcare Provider Details

I. General information

NPI: 1174106447
Provider Name (Legal Business Name): REGINA MARIE JAVIER DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2021
Last Update Date: 08/30/2023
Certification Date: 08/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4050 BEYER BLVD
SAN DIEGO CA
92173-2007
US

IV. Provider business mailing address

8835 SPECTRUM CENTER BLVD APT 4215
SAN DIEGO CA
92123-1484
US

V. Phone/Fax

Practice location:
  • Phone: 619-662-4100
  • Fax:
Mailing address:
  • Phone: 813-340-7314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDDS108695
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD011146
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: