Provider Demographics
NPI:1205226875
Name:S. JANG DDS INCORPORATED
Entity Type:Organization
Organization Name:S. JANG DDS INCORPORATED
Other - Org Name:SMILE TIME DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-781-6550
Mailing Address - Street 1:2260 E BIDWELL ST
Mailing Address - Street 2:# 351
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-3463
Mailing Address - Country:US
Mailing Address - Phone:916-781-6550
Mailing Address - Fax:916-984-4248
Practice Address - Street 1:2260 E BIDWELL ST
Practice Address - Street 2:# 110
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-3463
Practice Address - Country:US
Practice Address - Phone:916-984-4224
Practice Address - Fax:916-984-4248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-03
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57611122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty