Provider Demographics
NPI:1154930451
Name:HEALY, JASMINE (DDS)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:HEALY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:93 KANSAS ST APT 402
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-1473
Mailing Address - Country:US
Mailing Address - Phone:808-772-7526
Mailing Address - Fax:
Practice Address - Street 1:40335 WINCHESTER RD STE G
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-5518
Practice Address - Country:US
Practice Address - Phone:951-296-6760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-23
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1050711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice