Jefferson Dental | |
79800 Highway 111 Ste 109 La Quinta CA 92253-6003 | |
(760) 775-0600 | |
(760) 775-0663 |
Full Name | Jefferson Dental |
---|---|
Speciality | Dentist - General Practice |
Location | 79800 Highway 111 Ste 109, La Quinta, California |
Authorized Official Name and Position | Syeda Shabnam Huq (OWNER) |
Authorized Official Contact | 7607750600 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Jefferson Dental 79800 Highway 111 Ste 109 La Quinta CA 92253-6003 Ph: (760) 775-0600 | Jefferson Dental 79800 Highway 111 Ste 109 La Quinta CA 92253-6003 Ph: (760) 775-0600 |
NPI Number | 1154638500 |
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Provider Enumeration Date | 09/07/2010 |
Last Update Date | 09/07/2010 |
Identifier | Type | State | Issuer |
---|---|---|---|
1154638500 | NPI | - | NPPES |
1861669533 | Medicaid | CA | |
1861612954 | Medicaid | CA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1223G0001X | Dentist - General Practice | 56971 (California) | Secondary |
1223G0001X | Dentist - General Practice | 44484 (California) | Primary |
Larry Kunkle, Dds, Apc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 78640 Highway 111, La Quinta, CA 92253 Phone: 760-564-0955 | |
Huq Dds Inc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 79800 Highway 111 Ste 109, La Quinta, CA 92253 Phone: 760-775-0600 Fax: 760-775-0663 | |
Rita Christine Soto Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 78900 Avenue 47, Ste. 110, La Quinta, CA 92253 Phone: 760-771-8334 Fax: 760-771-8337 | |