Provider Demographics
NPI:1083212591
Name:REBECCA JARDINE, DDS, INC.
Entity Type:Organization
Organization Name:REBECCA JARDINE, DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:JARDINE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:510-414-6840
Mailing Address - Street 1:75 CALIFORNIA AVE
Mailing Address - Street 2:
Mailing Address - City:ORINDA
Mailing Address - State:CA
Mailing Address - Zip Code:94563-2105
Mailing Address - Country:US
Mailing Address - Phone:510-414-6840
Mailing Address - Fax:
Practice Address - Street 1:915 VILLAGE CTR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-3504
Practice Address - Country:US
Practice Address - Phone:510-414-6840
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-16
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental