Provider Demographics
NPI:1295775252
Name:JETTON, JAMES KEVIN (DDS)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:KEVIN
Last Name:JETTON
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 1:37441 IRONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:YUCAIPA
Mailing Address - State:CA
Mailing Address - Zip Code:92399-7024
Mailing Address - Country:US
Mailing Address - Phone:909-518-4133
Mailing Address - Fax:909-790-7206
Practice Address - Street 1:YUCAIPA VALLEY SPANISH SDA CHURCH
Practice Address - Street 2:12504 4TH ST
Practice Address - City:YUCAIPA
Practice Address - State:CA
Practice Address - Zip Code:92399
Practice Address - Country:US
Practice Address - Phone:909-518-4133
Practice Address - Fax:909-790-7206
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33939122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist