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General NPI Number Information
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NPI Number | 1790559797
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Entity Type | Organization
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Legal Business Name | JAVDAN DENTAL INC.
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Dates
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Enumeration Date | 11/09/2023
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Last Update Date | 11/09/2023
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Provider Practice Location Address
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Address Line | 3927 WARING RD STE E
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City | OCEANSIDE
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State | CA
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Zip | 92056-4458
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Country | US
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Telephone | 760-295-6475
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Fax | 760-295-6480
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Provider Business Mailing Address
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Address Line | 1521 DIAMOND PARK LN
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City | ROSEVILLE
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State | CA
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Zip | 95747-4611
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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 | PRESIDENT
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Name | BEHDAD JAVDAN
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Credential | DDS
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Telephone | 310-403-3479
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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