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General NPI Number Information
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NPI Number | 1780179218
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Entity Type | Organization
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Legal Business Name | JH DENTAL
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Dates
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Enumeration Date | 06/27/2018
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Last Update Date | 06/27/2018
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Provider Practice Location Address
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Address Line | 42104 N VENTURE DR
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City | ANTHEM
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State | AZ
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Zip | 85086-3823
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Country | US
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Telephone | 623-551-6300
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Fax |
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Provider Business Mailing Address
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Address Line | 9533 W BLUE SKY DR
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City | PEORIA
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State | AZ
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Zip | 85383-8741
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | JACOB HOLLY
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Credential | DMD
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Telephone | 623-692-4774
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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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