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General NPI Number Information
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NPI Number | 1902351414
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Entity Type | Organization
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Legal Business Name | JAK DENTAL, PLLC
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Dates
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Enumeration Date | 08/25/2016
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Last Update Date | 08/25/2016
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Provider Practice Location Address
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Address Line | 10121 LAKE JUNE RD 118
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City | DALLAS
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State | TX
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Zip | 75217-3002
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Country | US
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Telephone | 949-413-4940
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Fax |
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Provider Business Mailing Address
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Address Line | 3110 THOMAS AVE 339
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City | DALLAS
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State | TX
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Zip | 75204-2729
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Country | US
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Telephone | 949-413-4940
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | HAMID KASHANI
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Credential | DDS
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Telephone | 949-413-4940
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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 | 24349
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License Number State | TX
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