Provider Demographics
NPI:1700145273
Name:JARED R. GIANQUINTO, DMD, MS, INC A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:JARED R. GIANQUINTO, DMD, MS, INC A PROFESSIONAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JARED
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:GIANQUINTO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:661-215-4995
Mailing Address - Street 1:1400 CALLOWAY DR
Mailing Address - Street 2:SUITE 206
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93312-2826
Mailing Address - Country:US
Mailing Address - Phone:661-215-4995
Mailing Address - Fax:888-527-3506
Practice Address - Street 1:1400 CALLOWAY DR
Practice Address - Street 2:SUITE 206
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93312-2826
Practice Address - Country:US
Practice Address - Phone:661-215-4995
Practice Address - Fax:888-527-3506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-03
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA547561223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty