Provider Demographics
NPI:1265653828
Name:JUNGMAN, WILLIAM R (DDS)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:R
Last Name:JUNGMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 W.EL NORTE PKWY.
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92026-3983
Mailing Address - Country:US
Mailing Address - Phone:760-489-5545
Mailing Address - Fax:760-489-5546
Practice Address - Street 1:500 W.EL NORTE PKWY.
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92026-3983
Practice Address - Country:US
Practice Address - Phone:760-489-5545
Practice Address - Fax:760-489-5546
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28727122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist