Healthcare Provider Details

I. General information

NPI: 1588782833
Provider Name (Legal Business Name): WON MOON YOON D.D.S.,M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: ROBERT W YOON D.D.S.,M.S.

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8092 EDWIN RAYNOR BLVD
PASADENA MD
21122-6833
US

IV. Provider business mailing address

10740 RED DAHLIA DR
WOODSTOCK MD
21163-1430
US

V. Phone/Fax

Practice location:
  • Phone: 410-255-0200
  • Fax: 410-360-1747
Mailing address:
  • Phone: 410-750-7778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number12120
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: