Jesse Michael Fa, D.D.S

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

55360 Issued in CA

Practice address

2201 Balfour Rd Ste E
Brentwood, CA 94513-4927

Phone

(925) 308-7908

Fax

(925) 308-7910

NPI assigned

Apr 11, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Jesse M. Fa, DDS, Inc

  • Oral and Maxillofacial Surgery (Dentist)
  • Brentwood, CA
  • NPI 1649689597
  NPD Authorized official
• Jesse M. Fa, DDS, Inc

  • Oral and Maxillofacial Surgery (Dentist)
  • Antioch, CA
  • NPI 1104349760
  NPD (past) Authorized official

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

{
    "created_epoch": "1176249600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586304000000",
    "number": "1629291091",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "317 WINDMILL CANYON PL",
            "city": "CLAYTON",
            "state": "CA",
            "postal_code": "945171904",
            "telephone_number": "415-519-5620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2201 BALFOUR RD STE E",
            "city": "BRENTWOOD",
            "state": "CA",
            "postal_code": "945134927",
            "telephone_number": "925-308-7908",
            "fax_number": "925-308-7910"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2390 Country Hills Dr Ste 103",
            "address_purpose": "LOCATION",
            "city": "Antioch",
            "state": "CA",
            "postal_code": "945097437",
            "country_code": "US",
            "telephone_number": "925-757-2217",
            "fax_number": "925-757-6417",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FA",
        "first_name": "JESSE",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "D.D.S",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-11",
        "last_updated": "2020-04-08",
        "certification_date": "2020-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CA",
            "license": "55360",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Canisha Evans Miles
• Ronnica Evans
• Jalen Evers Threatt
• Exodyne, Inc.
• Eyecare Galleria Optometry
• Bowra Faiez, LICENSED MFT
• Mushda Faiez
• Mia Falco
• Brianna Marie Farber
• Syed U. Farooq

• Oral and Maxillofacial Surgery (Dentist) in Brentwood, CA
• Providers in Brentwood, CA by specialty
• Oral and Maxillofacial Surgery (Dentist) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2020; 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.