Provider Demographics
NPI:1023376225
Name:JS DENTAL CLINIC, LLC
Entity Type:Organization
Organization Name:JS DENTAL CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTURIST
Authorized Official - Prefix:
Authorized Official - First Name:LOLITA
Authorized Official - Middle Name:GUEVARRA
Authorized Official - Last Name:SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:DENTURIST
Authorized Official - Phone:206-661-0520
Mailing Address - Street 1:9735 S 222ND ST
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98031-2410
Mailing Address - Country:US
Mailing Address - Phone:206-661-0520
Mailing Address - Fax:
Practice Address - Street 1:9735 S 222ND ST
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98031-2410
Practice Address - Country:US
Practice Address - Phone:206-661-0520
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-25
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA603197556261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental