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Organization
JG DENTAL PLLC
Active
Organization
JG DENTAL PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GRACE S PARK DDS (OWNER MANAGER)
(623) 738-4904
Entity
Organization
Contact information
Practice address
4901 W BELL RD STE 140, GLENDALE, AZ 85308-3465
(623) 738-4904
Mailing address
10111 N EL MIRAGE RD STE 4, EL MIRAGE, AZ 85335-3605
(623) 738-4904
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
NULL
Other
Enumeration date
10/25/2018
Last updated
10/25/2018
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