Provider Demographics
NPI:1205010543
Name:MOJICA-JARA, MARJORIE A (DMD)
Entity type:Individual
Prefix:DR
First Name:MARJORIE
Middle Name:A
Last Name:MOJICA-JARA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5200 STOCKTON BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95820-5455
Mailing Address - Country:US
Mailing Address - Phone:916-455-6600
Mailing Address - Fax:916-455-4638
Practice Address - Street 1:3609 MISSION AVE
Practice Address - Street 2:SUITE B
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-2955
Practice Address - Country:US
Practice Address - Phone:916-488-5781
Practice Address - Fax:916-488-5973
Is Sole Proprietor?:No
Enumeration Date:2007-12-21
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD56569122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG90179-53Medicaid