Provider Demographics
NPI:1831210830
Name:TAROLA, JEFFREY P (DDS)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:P
Last Name:TAROLA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 CASS ST STE B2
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-4515
Mailing Address - Country:US
Mailing Address - Phone:831-375-3206
Mailing Address - Fax:831-375-3206
Practice Address - Street 1:1010 CASS ST STE B2
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-4515
Practice Address - Country:US
Practice Address - Phone:831-375-3206
Practice Address - Fax:831-375-3206
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA280971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB-28097-01OtherDENTI-CAL