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General NPI Number Information
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NPI Number | 1316489990
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Entity Type | Organization
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Legal Business Name | JMJ DDS LLC
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Dates
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Enumeration Date | 11/14/2016
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Last Update Date | 11/14/2016
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Provider Practice Location Address
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Address Line | 1823 BOSTON POST RD
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City | WESTBROOK
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State | CT
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Zip | 06498-2048
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Country | US
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Telephone | 860-399-7971
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Fax |
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Provider Business Mailing Address
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Address Line | 1823 BOSTON POST RD
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City | WESTBROOK
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State | CT
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Zip | 06498-2048
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Country | US
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Telephone | 860-399-7971
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. JOHN M JOHNSON
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Credential | DDS
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Telephone | 860-399-7971
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 006800
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License Number State | CT
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