Provider Demographics
NPI:1043384456
Name:DONG, JIMMY ROBERT (DDS)
Entity Type:Individual
Prefix:MR
First Name:JIMMY
Middle Name:ROBERT
Last Name:DONG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:636 CHURCH ST
Mailing Address - Street 2:#721
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-4587
Mailing Address - Country:US
Mailing Address - Phone:847-475-6606
Mailing Address - Fax:
Practice Address - Street 1:636 CHURCH ST
Practice Address - Street 2:#721
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-4587
Practice Address - Country:US
Practice Address - Phone:847-475-6606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist