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NPI Code Detail

MEDICARE: JENNIFER ALDAWOODI DMD, PROFESSIONAL CORP

MEDICARE: JENNIFER ALDAWOODI DMD, PROFESSIONAL CORP
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
1261QD0000XDental Clinic/Center

General Provider Information

NPI Number : 1649864877
Entity Type Code : Organization
Provider Name (Legal Business Name) : JENNIFER ALDAWOODI DMD, PROFESSIONAL CORP
Provider Business Mailing Address
First Line : 5531 CANCHA DE GOLF STE 102
Second Line :
City : RANCHO SANTA FE
State : CA
Zip : 92091-4625
Country : US
Telephone Number : 858-367-3058
Fax Number : 858-225-5954
Provider Business Practice Location Address
First Line : 5531 CANCHA DE GOLF STE 102
Second Line :
City : RANCHO SANTA FE
State : CA
Zip : 92091-4625
Country : US
Telephone Number : 858-367-3058
Fax Number : 858-225-5954
Authorized Official
Title or Position : PRESIDENT
Name : DR. KATHRINA AGATEP
Credential : DDS
Telephone Number : 858-367-3058
Provider Enumeration Date : 02/28/2021
Last Update Date : 02/28/2021

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