| North Jackson Dental Group | |
|
125 N Jackson Ave Suite #104 San Jose CA 95116 | |
| (408) 923-8272 | |
| (408) 923-8211 |
| Full Name | North Jackson Dental Group |
|---|---|
| Speciality | Dentist |
| Location | 125 N Jackson Ave, San Jose, California |
| Authorized Official Name and Position | Hue My To (VICE PRESIDENT OF THE CORPORATION) |
| Authorized Official Contact | 4089238272 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| North Jackson Dental Group 125 N Jackson Ave Suite #104 San Jose CA 95116 Ph: (408) 923-8272 | North Jackson Dental Group 125 N Jackson Ave Suite #104 San Jose CA 95116 Ph: (408) 923-8272 |
| NPI Number | 1023023884 |
|---|---|
| Provider Enumeration Date | 07/30/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023023884 | NPI | - | NPPES |
| G9089201 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 23951 (California) | Primary |
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