Provider Demographics
NPI:1801343322
Name:JAVIDAN DENTISTRY
Entity type:Organization
Organization Name:JAVIDAN DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTAL ASSISTANT/OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RHEA
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDOZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-271-0600
Mailing Address - Street 1:9420 MIRA MESA BLVD G
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126
Mailing Address - Country:US
Mailing Address - Phone:858-271-0600
Mailing Address - Fax:858-271-0809
Practice Address - Street 1:9420 MIRA MESA BLVD STE G
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-4848
Practice Address - Country:US
Practice Address - Phone:858-271-0600
Practice Address - Fax:858-271-0809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38303261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental