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General NPI Number Information
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NPI Number | 1477047652
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Entity Type | Individual
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Provider Name | JESSE TJAN DDS
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Gender | Male
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Dates
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Enumeration Date | 06/20/2018
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Last Update Date | 06/20/2018
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Provider Practice Location Address
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Address Line | 1433 E WABASH ST
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City | FRANKFORT
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State | IN
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Zip | 46041-2742
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Country | US
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Telephone | 765-670-6249
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Fax |
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Provider Business Mailing Address
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Address Line | 11 S MILL ST STE 200
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City | NEW CASTLE
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State | PA
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Zip | 16101-3680
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Country | US
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Telephone | 724-698-2132
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 12012947A
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License Number State | IN
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