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General NPI Number Information
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NPI Number | 1811481575
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Entity Type | Organization
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Legal Business Name | JASON KENJI REYDA, DDS, PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 06/18/2018
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Last Update Date | 06/18/2018
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Provider Practice Location Address
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Address Line | 5200 SNYDER LN STE 1
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City | ROHNERT PARK
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State | CA
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Zip | 94928-2931
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Country | US
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Telephone | 707-585-3160
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Fax |
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Provider Business Mailing Address
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Address Line | 5200 SNYDER LN STE 1
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City | ROHNERT PARK
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State | CA
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Zip | 94928-2931
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Country | US
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Telephone | 707-585-3160
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Fax |
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Authorized Official
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Title or Position | PRESIDENT, SECRETARY
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Name | DR. JASON KENJI REYDA
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Credential | DDS
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Telephone | 707-585-3160
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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