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General NPI Number Information
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NPI Number | 1538378575
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Entity Type | Organization
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Legal Business Name | JOG DENTAL CORPORATION
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 12/23/2008
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Provider Practice Location Address
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Address Line | 2975 BOWERS AVE SUITE 100
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City | SANTA CLARA
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State | CA
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Zip | 95051-0955
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Country | US
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Telephone | 408-987-0530
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Fax | 408-986-1337
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Provider Business Mailing Address
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Address Line | 2975 BOWERS AVE SUITE 100
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City | SANTA CLARA
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State | CA
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Zip | 95051-0955
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Country | US
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Telephone | 408-987-0530
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Fax | 408-986-1337
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ANAGHA B JOG
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Credential | DMD
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Telephone | 408-987-0530
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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 | 44707
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License Number State | CA
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