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General NPI Number Information
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NPI Number | 1700145273
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Entity Type | Organization
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Legal Business Name | JARED R. GIANQUINTO, DMD, MS, INC A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 05/03/2012
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Last Update Date | 11/29/2012
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Provider Practice Location Address
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Address Line | 1400 CALLOWAY DR SUITE 206
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City | BAKERSFIELD
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State | CA
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Zip | 93312-2826
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Country | US
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Telephone | 661-215-4995
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Fax | 888-527-3506
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Provider Business Mailing Address
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Address Line | 1400 CALLOWAY DR SUITE 206
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City | BAKERSFIELD
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State | CA
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Zip | 93312-2826
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Country | US
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Telephone | 661-215-4995
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Fax | 888-527-3506
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Authorized Official
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Title or Position | OWNER
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Name | DR. JARED ROBERT GIANQUINTO
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Credential | DMD, MS
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Telephone | 661-215-4995
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 54756
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License Number State | CA
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