Provider Demographics
NPI:1386464394
Name:JMS DENTAL CORPORATION
Entity type:Organization
Organization Name:JMS DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MIRNA
Authorized Official - Middle Name:ESTELA
Authorized Official - Last Name:VELASQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MAED
Authorized Official - Phone:714-661-6082
Mailing Address - Street 1:2184 AVOCADO DR
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92782-8346
Mailing Address - Country:US
Mailing Address - Phone:949-235-7515
Mailing Address - Fax:
Practice Address - Street 1:2184 AVOCADO DR
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92782-8346
Practice Address - Country:US
Practice Address - Phone:949-235-7515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-14
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental