Janisse Dental Inc

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

JANISSE DENTAL INC

Practice address

2615 N 4TH St Ste 6
Flagstaff, AZ 86004-1812

Phone

(928) 774-4761

NPI assigned

Jun 25, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Robert Janisse, DDS

Title

Owner

Phone

(925) 774-4761

Specialties & licenses 2

Addresses

Other names 1

• JANISSE DENTAL INC Former legal business name

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1624579200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1624579200000",
    "number": "1073183893",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2615 N 4TH ST STE 6",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860041812",
            "telephone_number": "928-774-4761"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2615 N 4TH ST STE 6",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860041812",
            "telephone_number": "928-774-4761"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JANISSE DENTAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-25",
        "last_updated": "2021-06-25",
        "certification_date": "2021-06-25",
        "status": "A",
        "authorized_official_last_name": "JANISSE",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "925-774-4761",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QS0112X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "JANISSE DENTAL INC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• James P Fredenberg MD PLLC
• Jocelyn L James, LMSW
• Mark S James, N.M.D.
• Theresa Elaine Janecek, BA, CMT
• Aundrea Janikowski
• Noah Janssen, PT, DPT
• Emma Jantz
• Kassandra Eleanor Jaramillo
• Roxana Yvonne Jaramillo
• Amber Jarvis, RDH

• Dental Clinic/Center in Flagstaff, AZ
• Providers in Flagstaff, AZ by specialty
• Dental Clinic/Center in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.