Healthcare Provider Details

I. General information

NPI: 1891029955
Provider Name (Legal Business Name): BRIAN PAUL JARDINA DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2009
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date: 02/13/2025
Reactivation Date: 03/03/2025

III. Provider practice location address

1395 CENTER DR
GAINESVILLE FL
32610-3006
US

IV. Provider business mailing address

2063 FUERTE ST
FALLBROOK CA
92028-4643
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-6775
  • Fax: 352-273-6553
Mailing address:
  • Phone: 412-874-0296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0008X
TaxonomyOral and Maxillofacial Radiology Dentistry
License Number58651
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: