Provider Demographics
NPI:1033494711
Name:TU DENTISTA PC
Entity Type:Organization
Organization Name:TU DENTISTA PC
Other - Org Name:TU DENTIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:JERNIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:214-431-3727
Mailing Address - Street 1:4807 MAPLE AVE
Mailing Address - Street 2:300
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-1006
Mailing Address - Country:US
Mailing Address - Phone:214-431-3727
Mailing Address - Fax:
Practice Address - Street 1:4101 ROSS AVE
Practice Address - Street 2:300
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-5138
Practice Address - Country:US
Practice Address - Phone:214-431-3727
Practice Address - Fax:214-635-3803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-13
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22494122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty