Provider Demographics
NPI:1326418344
Name:JEON, DAVID S (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID S
Middle Name:
Last Name:JEON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:DAVID SEONGHUN
Other - Middle Name:
Other - Last Name:JEON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:2535 W ROSAMOND BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:ROSAMOND
Mailing Address - State:CA
Mailing Address - Zip Code:93560-6266
Mailing Address - Country:US
Mailing Address - Phone:661-256-2500
Mailing Address - Fax:661-256-7561
Practice Address - Street 1:2535 W ROSAMOND BLVD STE B
Practice Address - Street 2:
Practice Address - City:ROSAMOND
Practice Address - State:CA
Practice Address - Zip Code:93560-6266
Practice Address - Country:US
Practice Address - Phone:661-256-2500
Practice Address - Fax:661-256-7561
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-02
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA417371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice