Provider Demographics
NPI:1366018657
Name:IM, EUNG JUN (PHD, DMD)
Entity Type:Individual
Prefix:DR
First Name:EUNG JUN
Middle Name:
Last Name:IM
Suffix:
Gender:M
Credentials:PHD, DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:396 NORTH RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01730-1016
Mailing Address - Country:US
Mailing Address - Phone:857-231-0200
Mailing Address - Fax:
Practice Address - Street 1:103 MERRIMACK ST
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01830-6208
Practice Address - Country:US
Practice Address - Phone:978-971-0060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-27
Last Update Date:2022-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1858996122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist