Provider Demographics
NPI:1114091162
Name:SEPULVEDA, JAIRO GIOVANNI (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAIRO
Middle Name:GIOVANNI
Last Name:SEPULVEDA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:JAIRO
Other - Middle Name:GIOVANNI
Other - Last Name:SEPULVEDA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:233 S MIRAGE AVE
Mailing Address - Street 2:
Mailing Address - City:LINDSAY
Mailing Address - State:CA
Mailing Address - Zip Code:93247-2543
Mailing Address - Country:US
Mailing Address - Phone:559-562-5969
Mailing Address - Fax:559-562-2358
Practice Address - Street 1:233 S MIRAGE AVE
Practice Address - Street 2:
Practice Address - City:LINDSAY
Practice Address - State:CA
Practice Address - Zip Code:93247-2543
Practice Address - Country:US
Practice Address - Phone:559-562-5969
Practice Address - Fax:559-562-2358
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49802122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist