Provider Demographics
NPI:1508165903
Name:SON, JEANETTE YOUNGJIN (DMD)
Entity Type:Individual
Prefix:DR
First Name:JEANETTE
Middle Name:YOUNGJIN
Last Name:SON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 ANNAND DR
Mailing Address - Street 2:SUITE #8
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-3719
Mailing Address - Country:US
Mailing Address - Phone:302-998-8283
Mailing Address - Fax:302-998-7299
Practice Address - Street 1:2601 ANNAND DR
Practice Address - Street 2:SUITE #8
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-3719
Practice Address - Country:US
Practice Address - Phone:302-998-8283
Practice Address - Fax:302-998-7299
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-24
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEG5-0001051122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist