MEDICARE: JJ DENTAL-4 PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1497601868
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JJ DENTAL-4 PLLC

Provider Business Mailing Address
First Line	:	2707 E COMMERCIAL BLVD
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-4112
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9818 PINES BLVD
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33024-6141
Country	:	US
Telephone Number	:	954-595-2231
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	JONATHAN COOK
Credential	:	DMD
Telephone Number	:	954-595-2231

Provider Enumeration Date	:	03/09/2026
Last Update Date	:	03/09/2026

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Directions to “JJ DENTAL-4 PLLC ” Practice Location

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