Jeffrey Phen DDS a Dental Corporation

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

44988 Issued in CA

Legal business name

JEFFREY PHEN DDS A DENTAL CORPORATION

Doing business as

Venetian Square Family Dental

Practice address

850 W March LN
Suite B
Stockton, CA 95207-6207

Phone

(209) 474-0888

Fax

(209) 474-3342

NPI assigned

Jan 10, 2008

Last updated

Jul 8, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Jeffrey Phen, DDSNPI 1043262744

Title

Dentist

Phone

(209) 474-0888

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Venetian Square Family Dental Doing business as

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jeffrey Phen, DDS

  • General Practice Dentistry
  • Stockton, CA
  • NPI 1043262744
  NPD (past) Authorized official
• Jacob Xavier Phen

  • General Practice Dentistry
  • Stockton, CA
  • NPI 1447973151
  NPD (past)

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

{
    "created_epoch": "1199923200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1278547200000",
    "number": "1740466572",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "850 W MARCH LN",
            "address_2": "SUITE B",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952076207",
            "telephone_number": "209-474-0888",
            "fax_number": "209-474-3342"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "850 W MARCH LN",
            "address_2": "SUITE B",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952076207",
            "telephone_number": "209-474-0888",
            "fax_number": "209-474-3342"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFREY PHEN DDS A DENTAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-10",
        "last_updated": "2010-07-08",
        "status": "A",
        "authorized_official_last_name": "PHEN",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "209-474-0888",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "44988",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DELTA DENTAL HEATHY FAMIL",
            "identifier": "G91849",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "G91849",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Venetian Square Family Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Jeanette Reed Family Chiropractic Wellness Center Inc.
• Renae Jefferson
• Jeffrey L Mansoor MD Inc
• Jeffrey Ryan Bennett (El Dorado Drug Store)
• S Star Jeffries
• Quinn Jeghers-Elam
• Edward Thomas Jellen, PT
• Peter Enojaine Jemerigbe, MSCE, PE, PMP

• General Practice Dentistry in Stockton, CA
• Providers in Stockton, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2010; 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.