Organization
JSC DENTAL STUDIO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JIM MISTO DDS (CEO)
(714) 723-1398
Entity
Organization
Contact information
Practice address
7372 WALNUT AVE STE C, BUENA PARK, CA 90620-1718
(714) 266-0523
Mailing address
2626 W BALL RD APT H1, ANAHEIM, CA 92804-5097
(714) 723-1398
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
07/10/2023
Last updated
07/14/2023
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