Provider Demographics
NPI:1144591140
Name:JDM PARTNERS LLC
Entity Type:Organization
Organization Name:JDM PARTNERS LLC
Other - Org Name:JENKINTOWN DENTAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF DENTAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:215-822-1866
Mailing Address - Street 1:200 HIGHPOINT DR
Mailing Address - Street 2:SUITE 220
Mailing Address - City:CHALFONT
Mailing Address - State:PA
Mailing Address - Zip Code:18914-3925
Mailing Address - Country:US
Mailing Address - Phone:215-822-1866
Mailing Address - Fax:
Practice Address - Street 1:123 OLD YORK RD
Practice Address - Street 2:SUITE 201
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-3926
Practice Address - Country:US
Practice Address - Phone:215-885-6565
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-23
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS027199L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty