Healthcare Provider Details

I. General information

NPI: 1376009175
Provider Name (Legal Business Name): JKA DENTAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2019
Last Update Date: 02/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1905 E MCKELLIPS RD
MESA AZ
85203-2865
US

IV. Provider business mailing address

1905 E MCKELLIPS RD
MESA AZ
85203-2865
US

V. Phone/Fax

Practice location:
  • Phone: 480-649-1949
  • Fax:
Mailing address:
  • Phone: 480-526-3664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. VINH HUYNH
Title or Position: DENTIST/OWNER
Credential: D.M.D
Phone: 480-526-3664