Provider Demographics
NPI:1174613566
Name:ROJAS, JAIME (DDS)
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:
Last Name:ROJAS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78640 HIGHWAY 111
Mailing Address - Street 2:
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92253-2048
Mailing Address - Country:US
Mailing Address - Phone:760-564-0955
Mailing Address - Fax:760-564-4826
Practice Address - Street 1:78640 HIGHWAY 111
Practice Address - Street 2:
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-2048
Practice Address - Country:US
Practice Address - Phone:760-564-0955
Practice Address - Fax:760-564-4826
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000098951223G0001X
CA57009122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist