NPIMap

Organization Active NPI

Jesse M. Fa, DDS, Inc

  • Oral and Maxillofacial Surgery (Dentist)
  • Antioch, CA
National Provider Identifier
1104349760
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
Legal business name
JESSE M. FA, DDS, INC
Practice address
2730 Lone Tree Way Ste 7
Antioch, CA 94509-4964
Phone
(925) 757-2217
Fax
(925) 757-6417
NPI assigned
Jul 25, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Jesse Michael Fa, DDSNPI 1629291091
Title
Owner
Phone
(925) 757-2217

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist)Group: 193400000X SINGLE SPECIALTY GROUP 1223S0112X CA Primary

Addresses

Primary practice location

2730 Lone Tree Way Ste 7
Antioch, CA 94509-4964

Mailing address

2730 Lone Tree Way Ste 7
Antioch, CA 94509-4964
Phone (925) 757-2217

Other practice location 1

2201 Balfour Rd Ste E
Brentwood, CA 94513-4927
Phone (925) 308-7908

National Provider Directory

National Provider Directory
Tax ID family
Blue Oak Oral Surgery Dental Implant Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1500940800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521244800000",
    "number": "1104349760",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2730 LONE TREE WAY STE 7",
            "city": "ANTIOCH",
            "state": "CA",
            "postal_code": "945094964",
            "telephone_number": "925-757-2217",
            "fax_number": "925-757-6417"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2730 LONE TREE WAY STE 7",
            "city": "ANTIOCH",
            "state": "CA",
            "postal_code": "945094964",
            "telephone_number": "925-757-2217",
            "fax_number": "925-757-6417"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2201 Balfour Rd Ste E",
            "address_purpose": "LOCATION",
            "city": "Brentwood",
            "state": "CA",
            "postal_code": "945134927",
            "country_code": "US",
            "telephone_number": "925-308-7908",
            "fax_number": "925-308-7910",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "JESSE M. FA, DDS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-25",
        "last_updated": "2018-03-17",
        "status": "A",
        "authorized_official_last_name": "FA",
        "authorized_official_first_name": "JESSE",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "925-757-2217",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Antioch, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.