Provider Demographics
NPI:1255718102
Name:JAVELLANA, GEMMA (DDS)
Entity type:Individual
Prefix:
First Name:GEMMA
Middle Name:
Last Name:JAVELLANA
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 1:1701 SOLAR DR STE 100
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030-0135
Mailing Address - Country:US
Mailing Address - Phone:805-983-1577
Mailing Address - Fax:
Practice Address - Street 1:1701 SOLAR DR STE 100
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-0135
Practice Address - Country:US
Practice Address - Phone:805-983-1577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-29
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA520651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice