Basic Information
| Provider Information | |||||||||
| NPI: | 1407460934 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JARIA | ||||||||
| FirstName: | ELIZA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DDS, MPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 135 FOREMOST DR APT 1305 | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787457336 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6504950994 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2301 CLEAR CREEK RD STE 106 | ||||||||
| Address2: | |||||||||
| City: | KILLEEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 765494198 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2542852014 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/02/2020 | ||||||||
| LastUpdateDate: | 09/13/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223X0400X | 36524 | TX | Y | Dental Providers | Dentist | Orthodontics and Dentofacial Orthopedics |
No ID Information.