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General NPI Number Information
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NPI Number | 1013786045
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Entity Type | Organization
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Legal Business Name | JEQUINTO DENTAL, INC
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Dates
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Enumeration Date | 01/02/2024
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Last Update Date | 01/04/2024
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Provider Practice Location Address
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Address Line | 7801 CENTER AVE STE 101
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92647-9112
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Country | US
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Telephone | 210-568-9800
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Fax |
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Provider Business Mailing Address
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Address Line | 7801 CENTER AVE STE 101
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92647-9112
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER DDS
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Name | DR. DAVE GOLDWYN JEQUINTO
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Credential |
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Telephone | 210-568-9800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223D0001X
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Taxonomy Name | Public Health Dentistry
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License Number |
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License Number State |
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