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General NPI Number Information
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NPI Number | 1598268419
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Entity Type | Organization
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Legal Business Name | JU DDS PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 03/16/2018
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Last Update Date | 03/16/2018
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Provider Practice Location Address
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Address Line | 899 ADAMS BLVD
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City | BOULDER CITY
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State | NV
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Zip | 89005-2235
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Country | US
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Telephone | 702-293-0373
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Fax | 702-293-3464
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Provider Business Mailing Address
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Address Line | 899 ADAMS BLVD
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City | BOULDER CITY
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State | NV
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Zip | 89005-2235
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Country | US
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Telephone | 702-293-0373
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Fax | 702-293-3464
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Authorized Official
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Title or Position | OWNER
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Name | NAKYOUNG JU
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Credential | DDS
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Telephone | 702-293-0373
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 6730
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License Number State | NV
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