Provider Demographics
NPI:1831632421
Name:JAFARI, HELIA
Entity type:Individual
Prefix:
First Name:HELIA
Middle Name:
Last Name:JAFARI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 RENAISSANCE PKWY STE 240
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92376-2418
Mailing Address - Country:US
Mailing Address - Phone:732-272-2862
Mailing Address - Fax:
Practice Address - Street 1:901 ABERNATHY RD
Practice Address - Street 2:UNIT 4010
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-2562
Practice Address - Country:US
Practice Address - Phone:732-272-2862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-30
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1036691223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics