Provider Demographics
NPI:1871792937
Name:JURASH, ROBERTA RITA (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERTA
Middle Name:RITA
Last Name:JURASH
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 1:411 4TH STREET
Mailing Address - Street 2:MARIN COUNTY DENTAL SERVICES
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901
Mailing Address - Country:US
Mailing Address - Phone:415-473-5450
Mailing Address - Fax:
Practice Address - Street 1:411 4TH ST
Practice Address - Street 2:MARIN COUNTY DENTAL SERVICES
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-5716
Practice Address - Country:US
Practice Address - Phone:415-473-5450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA530011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice