Provider Demographics
NPI:1013786045
Name:JEQUINTO DENTAL, INC
Entity Type:Organization
Organization Name:JEQUINTO DENTAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DDS
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVE
Authorized Official - Middle Name:GOLDWYN
Authorized Official - Last Name:JEQUINTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-568-9800
Mailing Address - Street 1:7801 CENTER AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-9112
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7801 CENTER AVE STE 101
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-9112
Practice Address - Country:US
Practice Address - Phone:210-568-9800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-02
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Single Specialty