Provider Demographics
NPI:1326280850
Name:JHB DENTAL ENTERPRISES, INC.
Entity Type:Organization
Organization Name:JHB DENTAL ENTERPRISES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:HANSEN
Authorized Official - Last Name:BAYLESS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:325-672-5988
Mailing Address - Street 1:250 BELTWAY N
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79601-8106
Mailing Address - Country:US
Mailing Address - Phone:325-672-5988
Mailing Address - Fax:325-672-5988
Practice Address - Street 1:2002 SUMMERS ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79603-1936
Practice Address - Country:US
Practice Address - Phone:325-672-5988
Practice Address - Fax:325-672-5988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-30
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12014261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1568507887Medicaid