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General NPI Number Information
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NPI Number | 1013443761
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Entity Type | Organization
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Legal Business Name | JNL DENTAL TWO
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Dates
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Enumeration Date | 05/01/2017
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Last Update Date | 05/01/2017
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Provider Practice Location Address
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Address Line | 1168 LAKEVIEW AVE STE 3
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City | DRACUT
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State | MA
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Zip | 01826-4763
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Country | US
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Telephone | 978-957-7009
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Fax |
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Provider Business Mailing Address
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Address Line | 1168 LAKEVIEW AVE STE 3
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City | DRACUT
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State | MA
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Zip | 01826-4763
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Country | US
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Telephone | 978-957-7009
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | DR. JAE YONG JUNG
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Credential |
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Telephone | 347-558-2076
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN1857532
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License Number State | MA
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