Provider Demographics
NPI:1124618962
Name:JT DENTAL GROUP PLLC
Entity type:Organization
Organization Name:JT DENTAL GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:JON
Authorized Official - Last Name:THIMJON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:651-423-1900
Mailing Address - Street 1:15180 CHIPPENDALE AVE W
Mailing Address - Street 2:
Mailing Address - City:ROSEMOUNT
Mailing Address - State:MN
Mailing Address - Zip Code:55068-1523
Mailing Address - Country:US
Mailing Address - Phone:651-423-1900
Mailing Address - Fax:651-423-6595
Practice Address - Street 1:15180 CHIPPENDALE AVE W
Practice Address - Street 2:
Practice Address - City:ROSEMOUNT
Practice Address - State:MN
Practice Address - Zip Code:55068-1523
Practice Address - Country:US
Practice Address - Phone:651-423-1900
Practice Address - Fax:651-423-6595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-26
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty