Organization Name: | THE DENTISTS CLINIC |
NPI Number: | 1093909558 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JEFFREY CHARLES JOHNSON (GENERAL PARTNER) |
Mailing Address: | 761 S Marine Corps Drive Suite A-2 Centam Building Tamuning |
State: | GU US |
Postal Code: | 96913 |
Phone Number: | 6716467982 |
Fax Number: | 6716467989 |
NPI Enumeration Date: | 08/28/2007 |
NPI Last Update Date: | 08/28/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1223P0221X |
License Number: | D 901 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | GU |
Taxonomy Type: | Dental Providers |
Taxonomy Classification: | Dentist |
Taxonomy Specialization: | Pediatric Dentistry |
Taxonomy Definition: | An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |