Provider Demographics
NPI:1689012486
Name:GARCIA-JASNY, ROGELIO M (DDS)
Entity Type:Individual
Prefix:
First Name:ROGELIO
Middle Name:M
Last Name:GARCIA-JASNY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10700 SANTA MONICA BLVD STE 140
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-6386
Mailing Address - Country:US
Mailing Address - Phone:310-470-6121
Mailing Address - Fax:
Practice Address - Street 1:10700 SANTA MONICA BLVD STE 140
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-6386
Practice Address - Country:US
Practice Address - Phone:310-470-6121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-13
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA616721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice