Provider Demographics
NPI:1194488304
Name:JAIN DENTAL BLAINE PLLC
Entity Type:Organization
Organization Name:JAIN DENTAL BLAINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:TROWBRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-227-6466
Mailing Address - Street 1:11800 ABERDEEN ST NE STE 110
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55449-4812
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11800 ABERDEEN ST NE STE 110
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55449-4812
Practice Address - Country:US
Practice Address - Phone:651-227-6646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-15
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental