Provider Demographics
NPI:1538603071
Name:JJJ DENTAL PC
Entity type:Organization
Organization Name:JJJ DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:MOLLISA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROMERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-652-2257
Mailing Address - Street 1:11403 BARKER CYPRESS RD STE 1300
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-5425
Mailing Address - Country:US
Mailing Address - Phone:281-318-5521
Mailing Address - Fax:800-507-8712
Practice Address - Street 1:11403 BARKER CYPRESS RD STE 1300
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-5425
Practice Address - Country:US
Practice Address - Phone:281-318-5521
Practice Address - Fax:800-507-8712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-16
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29063122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty