Jefferson Dental

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

44484 Issued in CA

Legal business name

JEFFERSON DENTAL

Practice address

79800 Highway 111 Ste 109
La Quinta, CA 92253-6003

Phone

(760) 775-0600

Fax

(760) 775-0663

NPI assigned

Sep 7, 2010

Organization subpart

No

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

Authorized official

Name

Dr. Syeda Shabnam Huq, DDS

Title

Owner

Phone

(760) 775-0600

Specialties & licenses 2

Addresses

Other identifiers 2

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

{
    "created_epoch": "1283817600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1283817600000",
    "number": "1154638500",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "79800 HIGHWAY 111 STE 109",
            "city": "LA QUINTA",
            "state": "CA",
            "postal_code": "922536003",
            "telephone_number": "760-775-0600",
            "fax_number": "760-775-0663"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "79800 HIGHWAY 111 STE 109",
            "city": "LA QUINTA",
            "state": "CA",
            "postal_code": "922536003",
            "telephone_number": "760-775-0600",
            "fax_number": "760-775-0663"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFERSON DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-07",
        "last_updated": "2010-09-07",
        "status": "A",
        "authorized_official_last_name": "HUQ",
        "authorized_official_first_name": "SYEDA",
        "authorized_official_middle_name": "SHABNAM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "760-775-0600",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "56971",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "44484",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1861669533",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1861612954",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jaime Rojas, DDS, Inc.
• Maria Jaimes, RDAEF2
• Shari Jainuddin, ND
• James S Manion, MD, Inc
• James William Almaraz
• Ronald Owen Jensen, O.D.
• JG Gonzalez Family Therapy, Inc
• Carol Theresa Johnson, RADT
• Kimberly Johnson
• Nina Ann Johnson

• General Practice Dentistry in La Quinta, CA
• Providers in La Quinta, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2010; 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.