Provider Demographics
NPI:1053513630
Name:JENTLE JADE LLC
Entity type:Organization
Organization Name:JENTLE JADE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:WAI KEE
Authorized Official - Middle Name:
Authorized Official - Last Name:FUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:845-595-6288
Mailing Address - Street 1:1614-0 UNION VALLEY RD
Mailing Address - Street 2:#310
Mailing Address - City:WEST MILFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07480
Mailing Address - Country:US
Mailing Address - Phone:845-595-6288
Mailing Address - Fax:845-595-2275
Practice Address - Street 1:2 OMNI CT
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-5211
Practice Address - Country:US
Practice Address - Phone:845-634-5925
Practice Address - Fax:845-634-8242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0483261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty