Provider Demographics
NPI:1487752069
Name:J.T. DENTAL CORP
Entity type:Organization
Organization Name:J.T. DENTAL CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SENIOR DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:TIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:415-759-7888
Mailing Address - Street 1:2323 NORIEGA ST
Mailing Address - Street 2:SUITE 208
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94122-4259
Mailing Address - Country:US
Mailing Address - Phone:415-759-7888
Mailing Address - Fax:
Practice Address - Street 1:2323 NORIEGA ST
Practice Address - Street 2:SUITE 208
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94122-4259
Practice Address - Country:US
Practice Address - Phone:415-759-7888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB37744122300000X
CAB38504122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty