Provider Demographics
NPI:1063636561
Name:JUNG, ROBERT W (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:W
Last Name:JUNG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:49 WELLES ST
Mailing Address - Street 2:SUITE 211
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-4205
Mailing Address - Country:US
Mailing Address - Phone:860-633-5246
Mailing Address - Fax:860-633-5249
Practice Address - Street 1:49 WELLES ST
Practice Address - Street 2:SUITE 211
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-4205
Practice Address - Country:US
Practice Address - Phone:860-633-5246
Practice Address - Fax:860-633-5249
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT44091223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry