Provider Demographics
NPI:1568974335
Name:HUR, JOON MITCHELL (DDS)
Entity Type:Individual
Prefix:
First Name:JOON
Middle Name:MITCHELL
Last Name:HUR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:JOON
Other - Middle Name:HEO
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:322 N PLACER PRIVADO
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91764-5666
Mailing Address - Country:US
Mailing Address - Phone:714-290-9607
Mailing Address - Fax:
Practice Address - Street 1:16120 S HIGHLAND AVE # 300
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336-1228
Practice Address - Country:US
Practice Address - Phone:909-232-8179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-01
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401415836122300000X
CA105252122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist