Provider Demographics
NPI:1740058254
Name:JET DENTAL OF MASSACHUSETTS
Entity type:Organization
Organization Name:JET DENTAL OF MASSACHUSETTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:K
Authorized Official - Last Name:HARDING
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:615-851-7102
Mailing Address - Street 1:1881 W TRAVERSE PKWY STE E
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-6029
Mailing Address - Country:US
Mailing Address - Phone:801-430-9262
Mailing Address - Fax:
Practice Address - Street 1:110 CHARLTON RD STE 25A
Practice Address - Street 2:
Practice Address - City:STURBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01566-1538
Practice Address - Country:US
Practice Address - Phone:801-430-9262
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-13
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty