Provider Demographics
NPI:1982964987
Name:JC DENTAL P.C.
Entity Type:Organization
Organization Name:JC DENTAL P.C.
Other - Org Name:HIGHLAND DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-546-2603
Mailing Address - Street 1:530 HIGHLAND STATION DR
Mailing Address - Street 2:SUITE #1006
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024
Mailing Address - Country:US
Mailing Address - Phone:678-546-2603
Mailing Address - Fax:678-546-2607
Practice Address - Street 1:530 HIGHLAND STATION DR
Practice Address - Street 2:SUITE #1006
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024
Practice Address - Country:US
Practice Address - Phone:678-546-2603
Practice Address - Fax:678-546-2607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-23
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA118561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000925889BMedicaid