Provider Demographics
NPI:1295302107
Name:JP DENTAL, PC
Entity type:Organization
Organization Name:JP DENTAL, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/ PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PHYLICIA
Authorized Official - Middle Name:R
Authorized Official - Last Name:COMBEST
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:228-249-2184
Mailing Address - Street 1:4808 WATERVIEW TOWN CENTER DR
Mailing Address - Street 2:SUITE 500
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407
Mailing Address - Country:US
Mailing Address - Phone:832-500-0664
Mailing Address - Fax:
Practice Address - Street 1:4808 WATERVIEW TOWN CENTER DR
Practice Address - Street 2:SUITE 500
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407
Practice Address - Country:US
Practice Address - Phone:832-500-0664
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-09
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty