Provider Demographics
NPI:1326320037
Name:UN, JEANNE C (DMD)
Entity Type:Individual
Prefix:DR
First Name:JEANNE
Middle Name:C
Last Name:UN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:745 BOYLSTON ST
Mailing Address - Street 2:SUITE 403
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-2636
Mailing Address - Country:US
Mailing Address - Phone:617-859-7107
Mailing Address - Fax:
Practice Address - Street 1:745 BOYLSTON ST
Practice Address - Street 2:SUITE 403
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-2636
Practice Address - Country:US
Practice Address - Phone:617-859-7107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-20
Last Update Date:2012-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60301056122300000X
MA1855836122300000X
RI03154122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist