Provider Demographics
NPI:1104204445
Name:JONG UM DDS, INC
Entity Type:Organization
Organization Name:JONG UM DDS, INC
Other - Org Name:SAME DAY DENTAL PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JONG
Authorized Official - Middle Name:
Authorized Official - Last Name:UM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:860-325-0022
Mailing Address - Street 1:9312 LA BIANCO ST
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33967-5641
Mailing Address - Country:US
Mailing Address - Phone:860-325-0022
Mailing Address - Fax:
Practice Address - Street 1:9312 LA BIANCO ST
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33967-5641
Practice Address - Country:US
Practice Address - Phone:860-325-0022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-06
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 207021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty