Provider Demographics
NPI:1790460798
Name:J&S DENTAL PC
Entity Type:Organization
Organization Name:J&S DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JINKYU
Authorized Official - Middle Name:
Authorized Official - Last Name:IM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:347-536-9017
Mailing Address - Street 1:3518 157TH ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-5024
Mailing Address - Country:US
Mailing Address - Phone:347-356-9017
Mailing Address - Fax:
Practice Address - Street 1:24 5TH AVE LBBY 3
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-8858
Practice Address - Country:US
Practice Address - Phone:347-536-9017
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-16
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental