Provider Demographics
NPI:1437419496
Name:JUNG, SEUNG SOO (DDS, MDS)
Entity Type:Individual
Prefix:DR
First Name:SEUNG
Middle Name:SOO
Last Name:JUNG
Suffix:
Gender:M
Credentials:DDS, MDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:885 BRADLEY ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-2979
Mailing Address - Country:US
Mailing Address - Phone:704-792-9637
Mailing Address - Fax:
Practice Address - Street 1:885 BRADLEY ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2979
Practice Address - Country:US
Practice Address - Phone:704-792-9637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-24
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC65761223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics