Provider Demographics
NPI:1578940904
Name:JPC DENTAL GROUP
Entity Type:Organization
Organization Name:JPC DENTAL GROUP
Other - Org Name:MILTON DENTAL SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHONG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:404-512-9355
Mailing Address - Street 1:13075 HIGHWAY 9 N
Mailing Address - Street 2:STE 110
Mailing Address - City:MILTON
Mailing Address - State:GA
Mailing Address - Zip Code:30004-5145
Mailing Address - Country:US
Mailing Address - Phone:404-512-9355
Mailing Address - Fax:
Practice Address - Street 1:13075 HIGHWAY 9 N
Practice Address - Street 2:STE 110
Practice Address - City:MILTON
Practice Address - State:GA
Practice Address - Zip Code:30004-5145
Practice Address - Country:US
Practice Address - Phone:404-512-9355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-06
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
122300000X
GADN0140851223P0221X
GADN0139231223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty