Provider Demographics
NPI:1124598230
Name:JC ORAL HEALTH CARE PA
Entity Type:Organization
Organization Name:JC ORAL HEALTH CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:JUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-332-0003
Mailing Address - Street 1:103 GREENE ST FL 2
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-3868
Mailing Address - Country:US
Mailing Address - Phone:201-332-0003
Mailing Address - Fax:201-266-4686
Practice Address - Street 1:103 GREENE ST FL 2
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-3868
Practice Address - Country:US
Practice Address - Phone:201-332-0003
Practice Address - Fax:201-266-4686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-01
Last Update Date:2018-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty