Provider Demographics
NPI:1477023489
Name:JACK HAROUNI DDS INC.
Entity Type:Organization
Organization Name:JACK HAROUNI DDS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:HAROUNI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:916-204-6625
Mailing Address - Street 1:815 LAKE OAK CT
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95864-6153
Mailing Address - Country:US
Mailing Address - Phone:916-971-0142
Mailing Address - Fax:
Practice Address - Street 1:1333 CAMINO DEL RIO S STE 202
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3520
Practice Address - Country:US
Practice Address - Phone:619-260-4990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-03
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental