Provider Demographics
NPI:1598977035
Name:CONCEPCION, MARY JUNE (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARY JUNE
Middle Name:
Last Name:CONCEPCION
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 1:5815 PALA MESA DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-4474
Mailing Address - Country:US
Mailing Address - Phone:408-972-7828
Mailing Address - Fax:408-719-0593
Practice Address - Street 1:1303 JACKLIN RD
Practice Address - Street 2:
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035-3426
Practice Address - Country:US
Practice Address - Phone:408-719-1197
Practice Address - Fax:408-719-0593
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46576122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist