Provider Demographics
NPI:1467962936
Name:JEFFREY M JAVELET DDS
Entity Type:Organization
Organization Name:JEFFREY M JAVELET DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RECEPTIONIST
Authorized Official - Prefix:
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:BAUMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RDA
Authorized Official - Phone:858-454-0366
Mailing Address - Street 1:7855 FAY AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-4267
Mailing Address - Country:US
Mailing Address - Phone:858-454-0366
Mailing Address - Fax:858-454-8786
Practice Address - Street 1:7855 FAY AVE STE 210
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-4267
Practice Address - Country:US
Practice Address - Phone:858-454-0366
Practice Address - Fax:858-454-8786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-10
Last Update Date:2017-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA293091223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty