Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 33198 | CA |
NPI | 1023298346 |
---|---|
Provider Name | Dr. Jared Fine |
First Address | Oakland, CA 94611-4099 |
Second Address | Oakland, CA 94607-4099 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/11/2007 |
Last Update Date | 06/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DDS33198 | (05) | CA |