Healthcare Provider Details

I. General information

NPI: 1871669655
Provider Name (Legal Business Name): JON JUHLIN DDS MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1810 W 8TH ST SUITE A
CEDAR FALLS IA
50613-2056
US

IV. Provider business mailing address

908 CARRIAGE LN
CEDAR FALLS IA
50613-1682
US

V. Phone/Fax

Practice location:
  • Phone: 319-266-7110
  • Fax: 319-266-7112
Mailing address:
  • Phone: 319-277-7155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number07381
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: