Provider Demographics
NPI:1346400371
Name:JAVIER JARA DDS INC.
Entity Type:Organization
Organization Name:JAVIER JARA DDS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAVIER
Authorized Official - Middle Name:E
Authorized Official - Last Name:JARA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-742-7279
Mailing Address - Street 1:820 SAN FERNANDO RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SAN FERNANDO
Mailing Address - State:CA
Mailing Address - Zip Code:91340-3321
Mailing Address - Country:US
Mailing Address - Phone:818-742-7279
Mailing Address - Fax:818-901-1586
Practice Address - Street 1:820 SAN FERNANDO RD
Practice Address - Street 2:SUITE 203
Practice Address - City:SAN FERNANDO
Practice Address - State:CA
Practice Address - Zip Code:91340-3321
Practice Address - Country:US
Practice Address - Phone:818-742-7279
Practice Address - Fax:818-901-1586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-12
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA000623591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty