Provider Demographics
NPI:1295504520
Name:JB DENTAL SERVICES, PLLC
Entity type:Organization
Organization Name:JB DENTAL SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:BASTIDA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:646-675-9671
Mailing Address - Street 1:110 GREEN ST APT C303
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11222-6290
Mailing Address - Country:US
Mailing Address - Phone:646-675-9671
Mailing Address - Fax:
Practice Address - Street 1:114 GREENPOINT AVE UNIT A
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11222-5768
Practice Address - Country:US
Practice Address - Phone:347-382-6814
Practice Address - Fax:347-382-6816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-28
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty