Provider Demographics
NPI:1952031486
Name:JA DENTAL GROUP PLLC
Entity Type:Organization
Organization Name:JA DENTAL GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR.
Authorized Official - Prefix:
Authorized Official - First Name:JEREMIAH
Authorized Official - Middle Name:
Authorized Official - Last Name:AIGBEDION
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:832-279-4326
Mailing Address - Street 1:21784 KATY FWY STE 200
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449-7790
Mailing Address - Country:US
Mailing Address - Phone:832-930-7741
Mailing Address - Fax:
Practice Address - Street 1:21784 KATY FWY STE 200
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449-7790
Practice Address - Country:US
Practice Address - Phone:832-930-7741
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-16
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty