Provider Demographics
NPI:1861502346
Name:JAVAHERI, DANIEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:JAVAHERI
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 1:1830 HACIENDA DR STE 1
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92081-4544
Mailing Address - Country:US
Mailing Address - Phone:760-295-9870
Mailing Address - Fax:760-295-9872
Practice Address - Street 1:35 MAIN ST
Practice Address - Street 2:#C-130
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-5858
Practice Address - Country:US
Practice Address - Phone:760-295-9870
Practice Address - Fax:760-295-9872
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52871122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist