Provider Demographics
NPI:1558876854
Name:PAUL M JIRAL DDS AND ASSOCIATES, PC
Entity Type:Organization
Organization Name:PAUL M JIRAL DDS AND ASSOCIATES, PC
Other - Org Name:ADVANTAGE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:M
Authorized Official - Last Name:JIRAL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:540-286-1110
Mailing Address - Street 1:560 CELEBRATE VA PKWY STE 107
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22406-7298
Mailing Address - Country:US
Mailing Address - Phone:540-286-1110
Mailing Address - Fax:540-286-3783
Practice Address - Street 1:560 CELEBRATE VA PKWY STE 107
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22406-7298
Practice Address - Country:US
Practice Address - Phone:540-286-1110
Practice Address - Fax:540-286-3783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-08
Last Update Date:2017-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401007285261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental