Provider Demographics
NPI:1447778220
Name:PAI, JACK (DDS)
Entity Type:Individual
Prefix:
First Name:JACK
Middle Name:
Last Name:PAI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:385 S MANCHESTER AVE UNIT 2048
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3247
Mailing Address - Country:US
Mailing Address - Phone:626-757-9906
Mailing Address - Fax:
Practice Address - Street 1:941 W MISSION BLVD STE H
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-6890
Practice Address - Country:US
Practice Address - Phone:909-984-7883
Practice Address - Fax:909-984-3463
Is Sole Proprietor?:No
Enumeration Date:2017-08-31
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS101787122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist