# JG DENTAL PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1659848828
- **Authorized official:** DR. GRACE S PARK DDS (OWNER MANAGER)
- **Authorized official phone:** (623) 738-4904

## Contact information

- **Practice address:** 4901 W BELL RD STE 140, GLENDALE, AZ 85308-3465
- **Practice address phone:** (623) 738-4904
- **Mailing address:** 10111 N EL MIRAGE RD STE 4, EL MIRAGE, AZ 85335-3605
- **Mailing address phone:** (623) 738-4904

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 10/25/2018
- **Last updated:** 10/25/2018