Provider Demographics
NPI:1033577317
Name:TJ DENTAL CORP
Entity Type:Organization
Organization Name:TJ DENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:SALINAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-899-0488
Mailing Address - Street 1:20542 N LAKE PLEASANT RD
Mailing Address - Street 2:STE #113
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-9749
Mailing Address - Country:US
Mailing Address - Phone:602-884-8238
Mailing Address - Fax:602-884-8240
Practice Address - Street 1:20542 N LAKE PLEASANT RD
Practice Address - Street 2:STE #113
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-9749
Practice Address - Country:US
Practice Address - Phone:602-884-8238
Practice Address - Fax:602-884-8240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-02
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty