Provider Demographics
NPI:1811425507
Name:JJ DENTAL PLLC
Entity type:Organization
Organization Name:JJ DENTAL PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JIYOUNG
Authorized Official - Middle Name:M
Authorized Official - Last Name:JUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:469-583-4092
Mailing Address - Street 1:1101 ALEXIS CT # 101
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-3338
Mailing Address - Country:US
Mailing Address - Phone:817-466-1200
Mailing Address - Fax:817-466-1201
Practice Address - Street 1:1101 ALEXIS CT # 101
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-3338
Practice Address - Country:US
Practice Address - Phone:817-466-1200
Practice Address - Fax:817-466-1201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-25
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX311811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX31181OtherDENTAL LICNESE