Provider Demographics
NPI:1649864877
Name:JENNIFER ALDAWOODI DMD, PROFESSIONAL CORP
Entity type:Organization
Organization Name:JENNIFER ALDAWOODI DMD, PROFESSIONAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:AGATEP
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:858-367-3058
Mailing Address - Street 1:5531 CANCHA DE GOLF STE 102
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA FE
Mailing Address - State:CA
Mailing Address - Zip Code:92091-4625
Mailing Address - Country:US
Mailing Address - Phone:858-367-3058
Mailing Address - Fax:858-225-5954
Practice Address - Street 1:5531 CANCHA DE GOLF STE 102
Practice Address - Street 2:
Practice Address - City:RANCHO SANTA FE
Practice Address - State:CA
Practice Address - Zip Code:92091-4625
Practice Address - Country:US
Practice Address - Phone:858-367-3058
Practice Address - Fax:858-225-5954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-28
Last Update Date:2021-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental