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General NPI Number Information
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NPI Number | 1992223440
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Entity Type | Individual
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Provider Name | JESSICA PHAN MACHADO DMD
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Gender | Female
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Dates
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Enumeration Date | 09/05/2017
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Last Update Date | 09/05/2017
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Provider Practice Location Address
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Address Line | 3991 GRAND AVE STE D
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City | CHINO
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State | CA
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Zip | 91710-5442
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Country | US
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Telephone | 909-591-0077
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Fax |
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Provider Business Mailing Address
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Address Line | 16008 LEGACY RD UNIT 307
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City | TUSTIN
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State | CA
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Zip | 92782-2812
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Country | US
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Telephone | 949-392-2827
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 65300
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License Number State | CA
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