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General NPI Number Information
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NPI Number | 1861182214
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Entity Type | Individual
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Provider Name | JARRAD LEE BSDH, RDA, RDH
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Gender | Male
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Dates
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Enumeration Date | 05/09/2023
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Last Update Date | 05/09/2023
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Provider Practice Location Address
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Address Line | 795 E 2ND ST FL 3
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City | POMONA
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State | CA
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Zip | 91766-2007
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Country | US
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Telephone | 909-706-3910
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Fax |
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Provider Business Mailing Address
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Address Line | 11612 SOLAIRE WAY
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City | CHINO
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State | CA
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Zip | 91710-7227
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Country | US
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Telephone | 310-621-3424
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 33483
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 126800000X
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Taxonomy Name | Dental Assistant
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License Number | 86792
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | CA
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