Organization Name: | JACK AND JILL PEDIATRIC DENTISTRY, LLC |
NPI Number: | 1184002180 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | NGUYET MINH TAU (DENTIST/OWNER) |
Mailing Address: | 340 Wood Rd Suite 288 Braintree |
State: | MA US |
Postal Code: | 021842401 |
Phone Number: | 6179138307 |
Fax Number: | |
NPI Enumeration Date: | 05/11/2015 |
NPI Last Update Date: | 05/11/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1223P0221X |
License Number: | 21959 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MA |
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. |