MEDICARE: JAMMA DENTAL DDS, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1538897897
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAMMA DENTAL DDS, INC.

Provider Business Mailing Address
First Line	:	1919 GRAND AVE STE 1P
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92109-4569
Country	:	US
Telephone Number	:	858-272-5588
Fax Number	:

Provider Business Practice Location Address
First Line	:	1919 GRAND AVE STE 1P
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92109-4569
Country	:	US
Telephone Number	:	619-634-5172
Fax Number	:

Authorized Official
Title or Position	:	OWNER DENTIST
Name	:	DALIA JAMMA
Credential	:	DDS
Telephone Number	:	858-272-5588

Provider Enumeration Date	:	08/12/2022
Last Update Date	:	02/09/2026

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