Provider Demographics
NPI:1689336711
Name:ANAS JEBRINI DDS PC
Entity Type:Organization
Organization Name:ANAS JEBRINI DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANAS
Authorized Official - Middle Name:
Authorized Official - Last Name:JEBRINI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:530-933-1712
Mailing Address - Street 1:6815 FIVE STAR BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95677-2691
Mailing Address - Country:US
Mailing Address - Phone:530-933-1712
Mailing Address - Fax:
Practice Address - Street 1:6815 FIVE STAR BLVD STE 110
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95677-2691
Practice Address - Country:US
Practice Address - Phone:530-933-1712
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-06
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty