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General NPI Number Information
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NPI Number | 1649169434
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Entity Type | Organization
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Legal Business Name | JAC DENTISTRY PC
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Dates
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Enumeration Date | 06/28/2025
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Last Update Date | 06/28/2025
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Provider Practice Location Address
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Address Line | 901 W CIVIC CENTER DR STE 180
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City | SANTA ANA
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State | CA
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Zip | 92703-2357
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Country | US
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Telephone | 714-650-9381
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Fax | 714-516-2234
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Provider Business Mailing Address
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Address Line | 901 W CIVIC CENTER DR STE 180
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City | SANTA ANA
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State | CA
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Zip | 92703-2357
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Country | US
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Telephone | 714-650-9381
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Fax | 714-516-2234
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Authorized Official
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Title or Position | OFFICE ADMINISTRATOR
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Name | MS. ALEJANDRA BERENICE DE ANDA
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Credential |
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Telephone | 714-650-9381
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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 |
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License Number State |
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