Provider Demographics
NPI:1013443761
Name:JNL DENTAL TWO
Entity Type:Organization
Organization Name:JNL DENTAL TWO
Other - Org Name:AFFORDABLE DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAE YONG
Authorized Official - Middle Name:
Authorized Official - Last Name:JUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-558-2076
Mailing Address - Street 1:1168 LAKEVIEW AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:DRACUT
Mailing Address - State:MA
Mailing Address - Zip Code:01826-4763
Mailing Address - Country:US
Mailing Address - Phone:978-957-7009
Mailing Address - Fax:
Practice Address - Street 1:1168 LAKEVIEW AVE STE 3
Practice Address - Street 2:
Practice Address - City:DRACUT
Practice Address - State:MA
Practice Address - Zip Code:01826-4763
Practice Address - Country:US
Practice Address - Phone:978-957-7009
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-01
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18575321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty