Organization
JKA DENTAL PLLC
Active
Other names
Eastport dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VINH HUYNH D.M.D (DENTIST/OWNER)
(480) 526-3664
Entity
Organization
Contact information
Practice address
1905 E MCKELLIPS RD, MESA, AZ 85203-2865
(480) 649-1949
Mailing address
1905 E MCKELLIPS RD, MESA, AZ 85203-2865
(480) 526-3664
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1376009175
PPO AND HMO
AZ
05
—
1376009175
—
AZ
01
—
1659659142
PPO AND HMO
AZ
05
—
1659659142
—
AZ
Enumeration date
02/16/2019
Last updated
02/17/2019
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