Provider Demographics
NPI:1023298346
Name:FINE, JARED (DDS)
Entity type:Individual
Prefix:DR
First Name:JARED
Middle Name:
Last Name:FINE
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 1:6991 EXETER DRIVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-4099
Mailing Address - Country:US
Mailing Address - Phone:510-326-2493
Mailing Address - Fax:510-208-5933
Practice Address - Street 1:1000 BROADWAY
Practice Address - Street 2:STE 500
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-4099
Practice Address - Country:US
Practice Address - Phone:510-208-5911
Practice Address - Fax:510-208-5933
Is Sole Proprietor?:No
Enumeration Date:2007-11-05
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA331981223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADDS33198Medicaid