Trey Stephen Jangaard, DDS
Individual provider Active NPI Dentist · Nipomo, CA
NPI 1316296155 · NPPES record last updated Sep 7, 2012
Key facts
- NPI
- 1316296155
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 61427 (CA)
- Practice address
- 150 Tejas PL
Nipomo, CA 93444-9123 - Phone
- (805) 931-2728
- Fax
- (805) 931-2737
- NPI assigned
- Sep 7, 2012
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 61427 | CA | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 61427 | CA | Yes |
Addresses
Primary practice location
150 Tejas PL
Nipomo, CA 93444-9123
Mailing address
150 Tejas PL
Nipomo, CA 93444-9123
Phone (805) 931-2728
Other providers in Nipomo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 7, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.