Provider Demographics
NPI:1568220846
Name:WILLIAM JEONG, DDS, P.A.
Entity Type:Organization
Organization Name:WILLIAM JEONG, DDS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:JEONG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:806-748-9797
Mailing Address - Street 1:2811 S LOOP 289 STE 12
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79423-1443
Mailing Address - Country:US
Mailing Address - Phone:806-748-9797
Mailing Address - Fax:
Practice Address - Street 1:2811 S LOOP 289 STE 12
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79423-1443
Practice Address - Country:US
Practice Address - Phone:806-748-9797
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty