Provider Demographics
NPI:1306947429
Name:QUEJADA, JAIME A (DMD,MS)
Entity type:Individual
Prefix:DR
First Name:JAIME
Middle Name:A
Last Name:QUEJADA
Suffix:
Gender:M
Credentials:DMD,MS
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:BUMED OFFICE OF THE MEDICAL INSPECTOR GENERAL
Mailing Address - Street 2:7700 ARLINGTON BLVD., STE 5134
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22042-5134
Mailing Address - Country:US
Mailing Address - Phone:202-288-7813
Mailing Address - Fax:
Practice Address - Street 1:1205 W VISTA WAY
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-6227
Practice Address - Country:US
Practice Address - Phone:760-941-5051
Practice Address - Fax:888-228-5701
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2023-10-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CADDS35196204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA33-0820906OtherTAX ID
CADC35196OtherLICENSE