Provider Demographics
NPI:1235486143
Name:BOGHAWALA, JESMINE (DDS, MPA, BDS)
Entity Type:Individual
Prefix:DR
First Name:JESMINE
Middle Name:
Last Name:BOGHAWALA
Suffix:
Gender:F
Credentials:DDS, MPA, BDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13017 ARTESIA BLVD STE D120
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-1391
Mailing Address - Country:US
Mailing Address - Phone:562-860-6626
Mailing Address - Fax:
Practice Address - Street 1:13017 ARTESIA BLVD STE D120
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-1391
Practice Address - Country:US
Practice Address - Phone:628-606-6266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-09
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61513122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist