Provider Demographics
NPI:1053888586
Name:DR J DENTAL AND ASSOCIATES
Entity type:Organization
Organization Name:DR J DENTAL AND ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICEPRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TATIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-709-6160
Mailing Address - Street 1:15940 SW 137TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-1278
Mailing Address - Country:US
Mailing Address - Phone:305-259-0080
Mailing Address - Fax:
Practice Address - Street 1:15940 SW 137TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33177-1278
Practice Address - Country:US
Practice Address - Phone:305-259-0080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-02
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental