Jesse M. Fa, DDS, Inc

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

55360 Issued in CA

Legal business name

JESSE M. FA, DDS, INC

Doing business as

Blue Oak Oral Surgery & Dental Implant Center

Practice address

2201 Balfour Rd Ste E
Brentwood, CA 94513-4927

Phone

(925) 308-7908

Fax

(925) 308-7910

NPI assigned

Aug 5, 2014

Last updated

Apr 8, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jesse Michael Fa, DDSNPI 1629291091

Title

Owner

Phone

(925) 757-2217

Specialties & licenses 1

Addresses

Other names 1

• Blue Oak Oral Surgery & Dental Implant Center Doing business as

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.

• Jesse M. Fa, DDS, Inc

  • Oral and Maxillofacial Surgery (Dentist)
  • Antioch, CA
  • NPI 1104349760
  NPD tax ID

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jesse Michael Fa, D.D.S

  • Oral and Maxillofacial Surgery (Dentist)
  • Brentwood, CA
  • NPI 1629291091
  NPD Authorized official
• Michael A. Arrow, D.M.D.

  • Oral and Maxillofacial Surgery (Dentist)
  • Brentwood, CA
  • NPI 1134123623
  NPD (past)

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

{
    "created_epoch": "1407196800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1586304000000",
    "number": "1649689597",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "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"
        },
        {
            "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": {
        "organization_name": "JESSE M. FA, DDS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-05",
        "last_updated": "2020-04-08",
        "certification_date": "2020-04-08",
        "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_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CA",
            "license": "55360",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Blue Oak Oral Surgery & Dental Implant Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Abigail Jeans
• Viennese Jefferson
• Jenaiah L Jones (Jenaiah L Sauceda LCSW)
• Valerie Chen Jerdee, M.D.
• Joanna Jeremy, LMFT
• Martha Jeane Jewell, PT PHD
• Laura Angelo Jimenez, P.T.
• JMJ Healthcare, Inc (JMJ Home Health Services)
• JMJ Hospice Care, Inc.
• Dianne Elizabeth Joachim-Romero, RDHAP

• 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.