Provider Demographics
NPI:1699854935
Name:BUENDIA, JAVIER REINALDO (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAVIER
Middle Name:REINALDO
Last Name:BUENDIA
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 1:2521 EAST FLORENCE AVE
Mailing Address - Street 2:SUITE B2
Mailing Address - City:HUNTINGTON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255
Mailing Address - Country:US
Mailing Address - Phone:323-582-4600
Mailing Address - Fax:323-582-4611
Practice Address - Street 1:2521 EAST FLORENCE AVE
Practice Address - Street 2:SUITE B2
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255
Practice Address - Country:US
Practice Address - Phone:323-582-4600
Practice Address - Fax:323-582-4611
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44839122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG9266201Medicare ID - Type Unspecified