Provider Demographics
NPI:1356115281
Name:JC FLASH SPA LLC
Entity type:Organization
Organization Name:JC FLASH SPA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD,
Authorized Official - Phone:850-567-4230
Mailing Address - Street 1:1621 1ST AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713-8935
Mailing Address - Country:US
Mailing Address - Phone:727-290-0929
Mailing Address - Fax:727-290-0919
Practice Address - Street 1:1621 1ST AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-8935
Practice Address - Country:US
Practice Address - Phone:727-290-0929
Practice Address - Fax:727-290-0919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-10
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental