Provider Demographics
NPI:1790228971
Name:JJC DENTAL PLLC
Entity Type:Organization
Organization Name:JJC DENTAL PLLC
Other - Org Name:CARE SMILE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:J
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-823-3688
Mailing Address - Street 1:350 LINCOLN ST STE 1106
Mailing Address - Street 2:
Mailing Address - City:HINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02043-1579
Mailing Address - Country:US
Mailing Address - Phone:781-749-7888
Mailing Address - Fax:781-749-9888
Practice Address - Street 1:350 LINCOLN ST STE 1106
Practice Address - Street 2:
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043-1579
Practice Address - Country:US
Practice Address - Phone:781-749-7888
Practice Address - Fax:781-749-9888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-21
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN215701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110078271AMedicaid