Provider Demographics
NPI:1245414986
Name:JEON, CHISON JUDY (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHISON
Middle Name:JUDY
Last Name:JEON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:CHI
Other - Middle Name:SON
Other - Last Name:JEON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:1215 ANNAPOLIS RD
Mailing Address - Street 2:STE 201
Mailing Address - City:ODENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21113-1349
Mailing Address - Country:US
Mailing Address - Phone:410-674-7400
Mailing Address - Fax:
Practice Address - Street 1:535 MAIN ST
Practice Address - Street 2:113
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-4335
Practice Address - Country:US
Practice Address - Phone:301-490-0044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-18
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD141761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice