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General NPI Number Information
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NPI Number | 1891029955
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Entity Type | Individual
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Provider Name | BRIAN PAUL JARDINA DMD
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Gender | Male
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Dates
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Enumeration Date | 09/22/2009
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Last Update Date | 03/24/2025
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Provider Practice Location Address
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Address Line | 1395 CENTER DR
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City | GAINESVILLE
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State | FL
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Zip | 32610-3006
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Country | US
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Telephone | 352-273-6775
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Fax | 352-273-6553
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Provider Business Mailing Address
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Address Line | 2063 FUERTE ST
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City | FALLBROOK
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State | CA
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Zip | 92028-4643
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Country | US
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Telephone | 412-874-0296
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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 | 1223X0008X
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Taxonomy Name | Oral and Maxillofacial Radiology Dentistry
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License Number | 58651
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License Number State | CA
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