Basic Information
| Provider Information | |||||||||
| NPI: | 1477023489 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | JACK HAROUNI DDS INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 815 LAKE OAK CT | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958646153 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9169710142 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1333 CAMINO DEL RIO S STE 202 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921083520 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6192604990 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/03/2018 | ||||||||
| LastUpdateDate: | 05/13/2022 | ||||||||
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| AuthorizedOfficialLastName: | HAROUNI | ||||||||
| AuthorizedOfficialFirstName: | JACK | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER/DENTIST | ||||||||
| AuthorizedOfficialTelephone: | 9162046625 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | DDS | ||||||||
| NPICertificationDate: | 05/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QD0000X | Y | Ambulatory Health Care Facilities | Clinic/Center | Dental |
No ID Information.