Healthcare Provider Details

I. General information

NPI: 1760597157
Provider Name (Legal Business Name): ROBERT G JAVA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4445 LACEY BLVD SE
LACEY WA
98503-5716
US

IV. Provider business mailing address

3401 COMMISSION CT SUITE 202
WOODBRIDGE VA
22192
US

V. Phone/Fax

Practice location:
  • Phone: 360-776-1244
  • Fax:
Mailing address:
  • Phone: 703-494-7799
  • Fax: 703-494-2412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number0401410048
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number70118618
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: