MEDICARE: DR. JEONG YOON JEON DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	2901020513	MI
2	1223G0001X	General Practice Dentistry	27364	TX

General Provider Information

NPI Number	:	1821379348
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEONG YOON JEON DDS

Provider Business Mailing Address
First Line	:	11834 HARRY HINES BLVD STE 109
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75234-5906
Country	:	US
Telephone Number	:	469-567-3810
Fax Number	:	469-567-3905

Provider Business Practice Location Address
First Line	:	11834 HARRY HINES BLVD STE 109
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75234-5906
Country	:	US
Telephone Number	:	469-567-3810
Fax Number	:	469-567-3905

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2011
Last Update Date	:	06/05/2023

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Directions to “ DR. JEONG YOON JEON DDS” Practice Location

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