Provider Demographics
NPI:1588227185
Name:JACQUELYN DO DDS INC.
Entity Type:Organization
Organization Name:JACQUELYN DO DDS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:ARTURO
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-495-2993
Mailing Address - Street 1:12835 POINTE DEL MAR WAY STE 2
Mailing Address - Street 2:
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-3846
Mailing Address - Country:US
Mailing Address - Phone:858-755-0050
Mailing Address - Fax:858-755-0059
Practice Address - Street 1:12835 POINTE DEL MAR WAY STE 2
Practice Address - Street 2:
Practice Address - City:DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92014-3846
Practice Address - Country:US
Practice Address - Phone:858-755-0050
Practice Address - Fax:858-755-0059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-18
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty