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General NPI Number Information
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NPI Number | 1437049988
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Entity Type | Organization
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Legal Business Name | JAB DENTAL INC.
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Dates
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Enumeration Date | 07/07/2025
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Last Update Date | 08/04/2025
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Provider Practice Location Address
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Address Line | 10218 CHESTNUT PLAZA DR
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City | FORT WAYNE
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State | IN
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Zip | 46814-8970
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Country | US
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Telephone | 260-616-1003
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Fax |
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Provider Business Mailing Address
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Address Line | 10218 CHESTNUT PLAZA DR
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City | FORT WAYNE
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State | IN
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Zip | 46814-8970
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Country | US
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Telephone | 260-616-1003
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Fax |
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. JESSE BLAIR
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Credential | DDS
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Telephone | 260-490-9684
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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 |
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License Number State |
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