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General NPI Number Information
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NPI Number | 1033765870
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Entity Type | Organization
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Legal Business Name | JESMINE BOGHAWALA DDS INC.
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Dates
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Enumeration Date | 08/16/2019
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Last Update Date | 08/16/2019
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Provider Practice Location Address
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Address Line | 10929 SOUTH ST STE 110B
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City | CERRITOS
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State | CA
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Zip | 90703-5365
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Country | US
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Telephone | 562-860-6626
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Fax | 562-860-6628
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Provider Business Mailing Address
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Address Line | 10929 SOUTH ST STE 110B
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City | CERRITOS
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State | CA
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Zip | 90703-5365
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Country | US
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Telephone | 562-860-6626
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Fax | 562-860-6628
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Authorized Official
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Title or Position | DENTIST
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Name | DR. JESMINE BOGHAWALA
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Credential | DDS
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Telephone | 562-860-6626
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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