MEDICARE: DR. JARI FAISON D.D.S.

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	1223P0221X	Pediatric Dentistry	37330	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831238005
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JARI FAISON D.D.S.

Provider Business Mailing Address
First Line	:	411 S LONG BEACH BLVD
Second Line	:
City	:	COMPTON
State	:	CA
Zip	:	90221-3427
Country	:	US
Telephone Number	:	310-537-2217
Fax Number	:

Provider Business Practice Location Address
First Line	:	411 S LONG BEACH BLVD
Second Line	:
City	:	COMPTON
State	:	CA
Zip	:	90221-3427
Country	:	US
Telephone Number	:	310-537-2217
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2007
Last Update Date	:	10/04/2012

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