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Organization
JEFFERSON DENTAL
Active
Organization
JEFFERSON DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SYEDA SHABNAM HUQ DDS (OWNER)
(760) 775-0600
Entity
Organization
Contact information
Practice address
79800 HIGHWAY 111 STE 109, LA QUINTA, CA 92253-6003
(760) 775-0600
(760) 775-0663
Mailing address
79800 HIGHWAY 111 STE 109, LA QUINTA, CA 92253-6003
(760) 775-0600
(760) 775-0663
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
44484
CA
1223G0001X
General Practice Dentistry
56971
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1861612954
—
CA
05
—
1861669533
—
CA
Enumeration date
09/07/2010
Last updated
09/07/2010
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