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General NPI Number Information
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NPI Number | 1033513874
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Entity Type | Organization
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Legal Business Name | J&J DENTAL GROUP
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Dates
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Enumeration Date | 10/21/2014
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Last Update Date | 10/21/2014
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Provider Practice Location Address
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Address Line | 2138 N JOSEY LN SUITE 104
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City | CARROLLTON
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State | TX
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Zip | 75006-3034
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Country | US
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Telephone | 972-242-4505
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Fax | 972-242-6420
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Provider Business Mailing Address
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Address Line | 130 TENNYSON PL
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City | COPPELL
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State | TX
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Zip | 75019-5365
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Country | US
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Telephone | 214-316-8919
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | JOON LEE
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Credential |
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Telephone | 972-242-4505
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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 | 26178
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License Number State | TX
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