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NPI Code Detail

MEDICARE: JTE DENTAL PLLC

MEDICARE: JTE DENTAL PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QD0000XDental Clinic/Center

General Provider Information

NPI Number : 1083503650
Entity Type Code : Organization
Provider Name (Legal Business Name) : JTE DENTAL PLLC
Provider Business Mailing Address
First Line : 16038 S 1ST AVE
Second Line :
City : PHOENIX
State : AZ
Zip : 85045-0508
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 10850 S 48TH ST
Second Line :
City : PHOENIX
State : AZ
Zip : 85044-1701
Country : US
Telephone Number : 480-893-1223
Fax Number :
Authorized Official
Title or Position : OWNER/MEMBER
Name : DR. JOSHUA EICHELBERGER
Credential : DMD
Telephone Number : 815-409-0549
Provider Enumeration Date : 06/30/2025
Last Update Date : 06/30/2025

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