Individual
JUSTINE TANJAYA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS, MS, PHD
Contact information
Practice address
1604 NEW YORK AVE, ARLINGTON, TX 76010-4724
(619) 549-6520
Mailing address
3790 CEDARPLAZA LN APT 2324, DALLAS, TX 75209-6379
(619) 549-6520
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
35540
TX
Other
Enumeration date
07/23/2019
Last updated
07/23/2019
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