| Organization Name: | JS HEALTHCARE DBA |
| NPI Number: | 1063779726 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ELLEN M NAM (DENTIST) |
| Mailing Address: | 3705 Lakeview Pkwy Ste. 101 Rowlett |
| State: | TX US |
| Postal Code: | 750884177 |
| Phone Number: | 9724752321 |
| Fax Number: | 8664962670 |
| NPI Enumeration Date: | 04/19/2012 |
| NPI Last Update Date: | 04/19/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | 22514 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |