Healthcare Provider Details

I. General information

NPI: 1386464394
Provider Name (Legal Business Name): JMS DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2024
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2184 AVOCADO DR
TUSTIN CA
92782-8346
US

IV. Provider business mailing address

2184 AVOCADO DR
TUSTIN CA
92782-8346
US

V. Phone/Fax

Practice location:
  • Phone: 949-235-7515
  • Fax:
Mailing address:
  • Phone: 949-235-7515
  • 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: MIRNA ESTELA VELASQUEZ
Title or Position: PARTNER/BUSINESS MANAGER
Credential: MAED
Phone: 714-661-6082