Provider Demographics
NPI:1225705932
Name:MOSAIC DENTAL GROUP
Entity Type:Organization
Organization Name:MOSAIC DENTAL GROUP
Other - Org Name:MOSAIC DENTAL GROUP OF ERIC JOO, DDS, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:JOO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:951-460-1477
Mailing Address - Street 1:308 W 6TH ST STE 207
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-3349
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:308 W 6TH ST STE 207
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-3349
Practice Address - Country:US
Practice Address - Phone:951-460-1477
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-30
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental