Provider Demographics
NPI:1477285385
Name:JL DENTAL GROUP LLC
Entity Type:Organization
Organization Name:JL DENTAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KWUNHO
Authorized Official - Middle Name:
Authorized Official - Last Name:JUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:217-722-6415
Mailing Address - Street 1:919 W KIRBY AVE
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61821-5121
Mailing Address - Country:US
Mailing Address - Phone:217-359-2500
Mailing Address - Fax:
Practice Address - Street 1:919 W KIRBY AVE
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61821-5121
Practice Address - Country:US
Practice Address - Phone:217-359-2500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JL DENTAL GROUP LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-06-29
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental