Provider Demographics
NPI:1346475316
Name:JONG UM DDS INC
Entity Type:Organization
Organization Name:JONG UM DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JONG
Authorized Official - Middle Name:
Authorized Official - Last Name:UM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-255-0108
Mailing Address - Street 1:21 SHERMAN CT
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-5825
Mailing Address - Country:US
Mailing Address - Phone:203-255-0108
Mailing Address - Fax:203-255-1239
Practice Address - Street 1:21 SHERMAN CT
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-5825
Practice Address - Country:US
Practice Address - Phone:203-255-0108
Practice Address - Fax:203-255-1239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-20
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0073751223G0001X
CT0067921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty