Active NPI 1821093832 Individual Practitioner Male Practitioner

Dr. Jack S Broussard , DDS

Dentist - General Practice • Pasadena, CA

Professional Overview & Biography Verified Profile Summary

Dr. Jack Broussard, DDS is a registered healthcare professional specializing in Dentist - General Practice in Pasadena, CA. Practice services are available at 301 S FAIR OAKS AVE under active NPI credentials.

Practice Location & Contact Primary Location

Practice Address

301 S Fair Oaks Ave
Ste 204

Pasadena, CA 911052536

Telephone 6267963161

Fax 6267966760

Associated Practice Facility / Clinic

🏢 Paul P. Shinto, D.d.s., Inc. Facility NPI 1548234594

Specialty Benchmarks & Practice Insights

Comparative analytics for Dentist - General Practice in Pasadena, CA

Active Practitioner

Practitioner Clinical Experience

Active

City Avg: 10.5 Yrs

State Avg: 21.7 Yrs

Regional Practice Density

110 Specialists

Practicing in Pasadena, CA (18734 Statewide)

Telehealth Adoption Rate

0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount

67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Dentist - General Practice Primary Specialty

NUCC Taxonomy Code: 1223G0001X

State License CA DN26040

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.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

1 Associated Practitioners

Dr. Sangho Byun , DDS

Dentist - Prosthodontics

NPI 1881043321

Doctor of Dental Surgery

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

6 Historical Events

✅

NPI Profile Active October 25, 2007

NPI status registered as active in NPPES database

📍

Updated Practice Location October 25, 2007

Registered at 301 S FAIR OAKS AVE, STE 204, PASADENA, CA 911052536 (Tel: 6267963161)

📍

Updated Business Mailing Address October 25, 2007

Registered at 301 S FAIR OAKS AVE, STE 204, PASADENA, CA 911052536 (Tel: 6267963161)

👤

Provider Name / Credentials Updated October 25, 2007

Recorded as JACK BROUSSARD, D.D.S.

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) October 25, 2007

Dentist (License #DN26040 in CA)

🟢

Initial NPI Registration & Enumeration June 16, 2005

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1821093832

Entity Type:

Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)

Enumeration Date: June 16, 2005

Last Update: October 25, 2007

Sole Proprietor: Yes

Update or Correct Profile

Mailing Address

301 S Fair Oaks Ave, Ste 204

Pasadena, CA 911052536

Phone: 6267963161

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).

⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.