Provider Demographics
NPI:1508264326
Name:DAVID C. JEN, DDS, INC., A DENTAL CORPORATION
Entity Type:Organization
Organization Name:DAVID C. JEN, DDS, INC., A DENTAL CORPORATION
Other - Org Name:SUNRISE DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:C
Authorized Official - Last Name:JEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-318-6318
Mailing Address - Street 1:1727 N. RIVERSIDE AVE.
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92376-8062
Mailing Address - Country:US
Mailing Address - Phone:626-318-6318
Mailing Address - Fax:
Practice Address - Street 1:1727 N. RIVERSIDE AVE.
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-8062
Practice Address - Country:US
Practice Address - Phone:909-961-2068
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-10
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA361591223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty