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General NPI Number Information
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NPI Number | 1366175804
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Entity Type | Organization
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Legal Business Name | JAVAN DENTAL CORPORATION
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Dates
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Enumeration Date | 07/01/2022
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Last Update Date | 07/01/2022
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Provider Practice Location Address
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Address Line | 1532 SAN BERNARDINO AVE STE A1
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City | POMONA
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State | CA
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Zip | 91767-3559
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Country | US
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Telephone | 714-414-2271
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Fax |
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Provider Business Mailing Address
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Address Line | 1532 SAN BERNARDINO AVE STE A1
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City | POMONA
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State | CA
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Zip | 91767-3559
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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 | DENTIST/OWNER
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Name | DR. NIMA NATHAN JAVAN
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Credential |
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Telephone | 714-414-2271
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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