Provider Demographics
NPI:1447423264
Name:JADES DENTISTRY
Entity Type:Organization
Organization Name:JADES DENTISTRY
Other - Org Name:JADES DENTISTRY
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LING
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:310-373-8520
Mailing Address - Street 1:23440 HAWTHORNE BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-4768
Mailing Address - Country:US
Mailing Address - Phone:310-373-8520
Mailing Address - Fax:310-373-0621
Practice Address - Street 1:23440 HAWTHORNE BLVD STE 110
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-4768
Practice Address - Country:US
Practice Address - Phone:310-373-8520
Practice Address - Fax:310-373-0621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-12
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42742261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental