Provider Demographics
NPI:1790888741
Name:JARDINE, REBECCA (DDS)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:JARDINE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 CALIFORNIA AVE
Mailing Address - Street 2:
Mailing Address - City:ORINDA
Mailing Address - State:CA
Mailing Address - Zip Code:94563-2105
Mailing Address - Country:US
Mailing Address - Phone:510-414-6840
Mailing Address - Fax:510-535-4128
Practice Address - Street 1:915 VILLAGE CTR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-3504
Practice Address - Country:US
Practice Address - Phone:510-414-6840
Practice Address - Fax:925-356-2499
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS501741223G0001X
CA501741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice