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General NPI Number Information
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NPI Number | 1801343322
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Entity Type | Organization
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Legal Business Name | JAVIDAN DENTISTRY
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Dates
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Enumeration Date | 09/01/2016
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Last Update Date | 09/01/2016
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Provider Practice Location Address
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Address Line | 9420 MIRA MESA BLVD STE G
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City | SAN DIEGO
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State | CA
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Zip | 92126-4848
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Country | US
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Telephone | 858-271-0600
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Fax | 858-271-0809
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Provider Business Mailing Address
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Address Line | 9420 MIRA MESA BLVD G
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City | SAN DIEGO
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State | CA
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Zip | 92126
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Country | US
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Telephone | 858-271-0600
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Fax | 858-271-0809
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Authorized Official
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Title or Position | DENTAL ASSISTANT/OFFICE MANAGER
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Name | RHEA MENDOZA
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Credential |
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Telephone | 858-271-0600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 38303
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License Number State | CA
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