Provider Demographics
NPI:1033513874
Name:J&J DENTAL GROUP
Entity Type:Organization
Organization Name:J&J DENTAL GROUP
Other - Org Name:BEVERLY DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JOON
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-242-4505
Mailing Address - Street 1:130 TENNYSON PL
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-5365
Mailing Address - Country:US
Mailing Address - Phone:214-316-8919
Mailing Address - Fax:
Practice Address - Street 1:2138 N JOSEY LN
Practice Address - Street 2:SUITE 104
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-3034
Practice Address - Country:US
Practice Address - Phone:972-242-4505
Practice Address - Fax:972-242-6420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-21
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty