Provider Demographics
NPI:1114138989
Name:JEON, GRACE E (D D S)
Entity Type:Individual
Prefix:DR
First Name:GRACE
Middle Name:E
Last Name:JEON
Suffix:
Gender:F
Credentials:D D S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 W 72ND ST
Mailing Address - Street 2:APT. 4C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-4162
Mailing Address - Country:US
Mailing Address - Phone:917-617-2202
Mailing Address - Fax:212-244-4522
Practice Address - Street 1:225 W 35TH ST
Practice Address - Street 2:2ND FL
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-1904
Practice Address - Country:US
Practice Address - Phone:212-564-8164
Practice Address - Fax:212-244-4522
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0524111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice