# JANISSE DENTAL INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** JANISSE DENTAL INC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1073183893
- **Authorized official:** ROBERT JANISSE DDS (OWNER)
- **Authorized official phone:** (925) 774-4761

## Contact information

- **Practice address:** 2615 N 4TH ST STE 6, FLAGSTAFF, AZ 86004-1812
- **Practice address phone:** (928) 774-4761
- **Mailing address:** 2615 N 4TH ST STE 6, FLAGSTAFF, AZ 86004-1812
- **Mailing address phone:** (928) 774-4761

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |
| 261QS0112X | Oral and Maxillofacial Surgery Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 06/25/2021
- **Last updated:** 06/25/2021