Provider Demographics
NPI:1306189089
Name:C AND J DENTAL GROUP, PLLC
Entity Type:Organization
Organization Name:C AND J DENTAL GROUP, PLLC
Other - Org Name:CJ DENTISTRY
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:SHUNG
Authorized Official - Middle Name:HYUN
Authorized Official - Last Name:JOH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-502-5025
Mailing Address - Street 1:18261 N PIMA RD
Mailing Address - Street 2:SUITE #E-130
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-6229
Mailing Address - Country:US
Mailing Address - Phone:480-502-5025
Mailing Address - Fax:480-502-5058
Practice Address - Street 1:18261 N PIMA RD
Practice Address - Street 2:SUITE #E-130
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-6229
Practice Address - Country:US
Practice Address - Phone:480-502-5025
Practice Address - Fax:480-502-5058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-01
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ67591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty