Provider Demographics
NPI:1225300163
Name:JO, HARRISON HOSUNG (DMD)
Entity Type:Individual
Prefix:DR
First Name:HARRISON
Middle Name:HOSUNG
Last Name:JO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10665 STANHAVEN PL # 104
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:MD
Mailing Address - Zip Code:20695-3055
Mailing Address - Country:US
Mailing Address - Phone:301-632-5480
Mailing Address - Fax:
Practice Address - Street 1:10665 STANHAVEN PL # 104
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:MD
Practice Address - Zip Code:20695-3055
Practice Address - Country:US
Practice Address - Phone:301-632-5480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-08
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS038324122300000X
MD15371122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist