Provider Demographics
NPI:1932386398
Name:JC DENTISTRY INC
Entity Type:Organization
Organization Name:JC DENTISTRY INC
Other - Org Name:JOHNSTON FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:A
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:515-270-9679
Mailing Address - Street 1:6108 NW 59TH CT
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:IA
Mailing Address - Zip Code:50131-1580
Mailing Address - Country:US
Mailing Address - Phone:515-270-9679
Mailing Address - Fax:
Practice Address - Street 1:6108 NW 59TH CT
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:IA
Practice Address - Zip Code:50131-1580
Practice Address - Country:US
Practice Address - Phone:515-270-9679
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-29
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA80481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1033241575OtherINDIVIDUAL NPI
IA1689743502OtherINDIVIDUAL NPI