Provider Demographics
NPI:1114137338
Name:JITEN M VASA, DDS., INC
Entity Type:Organization
Organization Name:JITEN M VASA, DDS., INC
Other - Org Name:LAKEWOOD FAMILY DENTISTRY
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JITEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:VASA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:562-860-7116
Mailing Address - Street 1:11455 CARSON ST STE E
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90715-2581
Mailing Address - Country:US
Mailing Address - Phone:562-860-7116
Mailing Address - Fax:562-860-7115
Practice Address - Street 1:11455 CARSON ST STE E
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90715-2581
Practice Address - Country:US
Practice Address - Phone:562-860-7116
Practice Address - Fax:562-860-7115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA300251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty