DR. JACK S BROUSSARD JR. (NPI# 1821093832) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1821093832 |
| Entity Type | Individual |
| Full Name | DR. JACK S BROUSSARD JR. |
| Credential | D.D.S. |
| Practice Address |
301 S Fair Oaks Ave Ste 204 Pasadena CA 91105-2536 |
| Practice Telephone | 6267963161 |
| Practice Fax Number | 6267966760 |
| Mailing Telephone | 6267963161 |
| Mailing Fax Number | 6267966760 |
| Enumeration Date | 2005-06-16 |
| Last Update Date | 2007-10-25 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
DN26040 | CA | Dental Providers |
| Street Address |
301 S FAIR OAKS AVE STE 204 |
| City | PASADENA |
| State | CA |
| Zip Code | 91105-2536 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528593357 | Souna Sarkis | Pharmacist | 301 S Fair Oaks Ave, Suite Number 104, Pasadena, CA 91105-2561 | 2017-04-30 |
| 1750740080 | Orange County Orofacial Pain Associates Inc | 301 S Fair Oaks Ave, Suite 402, Pasadena, CA 91105-2561 | 2016-02-15 | |
| 1740646124 | Kyung A Cho | Nurse Practitioner | 301 S Fair Oaks Ave, 404, Pasadena, CA 91105-2561 | 2016-01-14 |
| 1780066613 | Marlys R Drange, Md,inc | Internal Medicine | 301 S Fair Oaks Ave, Suite 105, Pasadena, CA 91105-2561 | 2015-06-27 |
| 1457775736 | Unicare Pharmacy & Supply Inc | Durable Medical Equipment & Medical Supplies | 301 S Fair Oaks Ave, Ste 104, Pasadena, CA 91105-2561 | 2014-02-07 |
| 1467886549 | Healthy Living Medical, Inc | Clinic/Center | 301 S Fair Oaks Ave, Suite 404, Pasadena, CA 91105-2561 | 2013-08-26 |
| 1255772554 | Michael E Steuer, Md, PC | Specialist | 301 S Fair Oaks Ave, Ste 105, Pasadena, CA 91105-2561 | 2013-07-15 |
| 1811234909 | Beauty Swe, Md, Inc. | Internal Medicine | 301 S Fair Oaks Ave, Suite 203, Pasadena, CA 91105-2561 | 2013-01-09 |
| 1134476195 | American Medical Evaluation Centers Inc | Internal Medicine | 301 S Fair Oaks Ave, Ste 107, Pasadena, CA 91105-2561 | 2012-08-09 |
| 1962760991 | Huntington Pain and Wellness Center, Inc | Anesthesiology | 301 S Fair Oaks Ave, Suite 402, Pasadena, CA 91105-2561 | 2012-04-27 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619451697 | Tonya Michlin | Registered Nurse | 800 Fairmount Ave Ste 110, Pasadena, CA 91105 | 2018-09-17 |
| 1639674161 | David Marcus Md, Inc. | Psychiatry & Neurology | 107 S. Fair Oaks Avenue, Suite #315, Pasadena, CA 91105 | 2018-03-27 |
| 1548778541 | Elias & Jun Dental Corp | Dentist | 301 S. Fair Oaks Ave., Ste 107, Pasadena, CA 91105 | 2018-01-12 |
| 1013429745 | Whitney Catalano | Dietitian, Registered | 100 S Orange Grove Blvd, 103, Pasadena, CA 91105 | 2017-11-03 |
| 1518485630 | Marlon O Miller | Counselor | 1020 South Arroyo Parkway, Pasadena, CA 91105 | 2017-09-08 |
| 1316469976 | Alexandra Scott | Speech-Language Pathologist | 235 La Vereda Road, Pasadena, CA 91105 | 2017-07-14 |
| 1346770443 | Amanda Grace Gentz | Rehabilitation Practitioner | 210 S De Lacey, Ste 110, Pasadena, CA 91105 | 2017-06-13 |
| 1427598390 | Melina Gomez Loza | Licensed Vocational Nurse | 66 Hilburt St #2, Pasadena, CA 91105 | 2017-02-27 |
| 1588115281 | Ramon Banuelos | Rehabilitation Practitioner | 210 S. Delacey Ave Suite 110, Pasadena, CA 91105 | 2016-10-18 |
| 1922554245 | Daniel Joseph Ybarra | Student in an Organized Health Care Education/Training Program | 100 W. California Blvd. Pasadena, Ca 91105, Pasadena, CA 91105 | 2016-08-28 |
| Find all providers in zip 91105 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578197208 | Dental Land Pllc | Dentist | 2525 Southmore Ave # Site200, Pasadena, TX 77502-1451 | 2020-03-03 |
| 1346801792 | Koutchekpour & Spero, A Professional Corporation | Dentist | 900 Valley View Ave Unit 2, Pasadena, CA 91107-1976 | 2019-06-26 |
| 1912563958 | Cisneros Dentistry Pllc | Dentist | 918 W Southmore Ave Ste 115, Pasadena, TX 77502-1020 | 2019-05-15 |
| 1649737008 | Top Dental Pasadena | Dentist | 950 E Colorado Blvd Ste 201, Pasadena, CA 91106-2300 | 2019-02-21 |
| 1225512551 | Winnie Liang | Dentist | 65 N Madison Ave Ste 506, Pasadena, CA 91101-2048 | 2018-09-22 |
| 1063920015 | Pasadena Dental Smile, Pllc | Dentist | 4002 Burke Rd # 100, Pasadena, TX 77504-3451 | 2018-01-11 |
| 1508372269 | Dong-gil Kang Dds Inc | Dentist | 668 N Los Robles Ave, Pasadena, CA 91101-1004 | 2017-12-18 |
| 1962912139 | H. Robert Stender, Dds, Inc. | Dentist | 200 S El Molino Ave Ste 6, Pasadena, CA 91101-2985 | 2017-10-02 |
| 1598293250 | Chandni P. Jogani, D.d.s. | Dentist | 175 S El Molino Ave Ste 6, Pasadena, CA 91101-2564 | 2017-05-25 |
| 1053843359 | Kyle Low | Dentist | 301 S Fair Oaks Ave Ste 205, Pasadena, CA 91105-2536 | 2017-03-28 |
| Find all providers in PASADENA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.