Organization
JANISSE DENTAL INC
Active
Other names
JANISSE DENTAL INC
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT JANISSE DDS (OWNER)
(925) 774-4761
Entity
Organization
Contact information
Practice address
2615 N 4TH ST STE 6, FLAGSTAFF, AZ 86004-1812
(928) 774-4761
Mailing address
2615 N 4TH ST STE 6, FLAGSTAFF, AZ 86004-1812
(928) 774-4761
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
261QS0112X
Oral and Maxillofacial Surgery Clinic/Center
—
—
Other
Enumeration date
06/25/2021
Last updated
06/25/2021
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