Healthcare Provider Details

I. General information

NPI: 1346890092
Provider Name (Legal Business Name): JESS ESCOBAR DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2019
Last Update Date: 09/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3772 SONOMA BLVD
VALLEJO CA
94589-2202
US

IV. Provider business mailing address

5322 CAROLE RIDGE CT
FAIRFIELD CA
94534-6785
US

V. Phone/Fax

Practice location:
  • Phone: 707-557-6680
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDDS104176
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: