Provider Demographics
NPI:1376982256
Name:D.JASULAITIS,DDS, INC
Entity type:Organization
Organization Name:D.JASULAITIS,DDS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAIVA
Authorized Official - Middle Name:RITA
Authorized Official - Last Name:JASULAITIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-795-1985
Mailing Address - Street 1:777 S ARROYO PKWY
Mailing Address - Street 2:#104
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3268
Mailing Address - Country:US
Mailing Address - Phone:626-795-1985
Mailing Address - Fax:626-795-0064
Practice Address - Street 1:777 S ARROYO PKWY
Practice Address - Street 2:#104
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3268
Practice Address - Country:US
Practice Address - Phone:626-795-1985
Practice Address - Fax:626-795-0064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-24
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31290261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental