Provider Demographics
NPI:1114063419
Name:JAKSHA, STEVEN FRANK (DMD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:FRANK
Last Name:JAKSHA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12395 EL CAMINO REAL STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-3083
Mailing Address - Country:US
Mailing Address - Phone:858-350-0337
Mailing Address - Fax:858-350-9644
Practice Address - Street 1:12395 EL CAMINO REAL STE 101
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-3083
Practice Address - Country:US
Practice Address - Phone:858-350-0337
Practice Address - Fax:858-350-9644
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADS312881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice