Provider Demographics
NPI:1184002180
Name:JACK AND JILL PEDIATRIC DENTISTRY, LLC
Entity Type:Organization
Organization Name:JACK AND JILL PEDIATRIC DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NGUYET
Authorized Official - Middle Name:MINH
Authorized Official - Last Name:TAU
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-864-8997
Mailing Address - Street 1:340 WOOD ROAD
Mailing Address - Street 2:SUITE 288
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:340 WOOD RD
Practice Address - Street 2:SUITE 288
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-2401
Practice Address - Country:US
Practice Address - Phone:617-913-8307
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-11
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA219591223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty