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General NPI Number Information
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NPI Number | 1346524600
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Entity Type | Individual
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Provider Name | JURA JUNG DDS
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Gender | Female
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Dates
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Enumeration Date | 10/05/2011
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Last Update Date | 10/05/2011
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Provider Practice Location Address
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Address Line | 3824 MECHANICSVILLE TPKE UNIT 12
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City | RICHMOND
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State | VA
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Zip | 23223-1114
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Country | US
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Telephone | 804-321-5665
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Fax |
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Provider Business Mailing Address
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Address Line | 1090 NORTHCHASE PKWY SE STE 290
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City | MARIETTA
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State | GA
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Zip | 30067-6402
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Country | US
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Telephone | 770-916-5352
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 0401413379
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License Number State | VA
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