Provider Demographics
NPI:1710327614
Name:RYU, HOJOONG (DDS)
Entity Type:Individual
Prefix:DR
First Name:HOJOONG
Middle Name:
Last Name:RYU
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:DAVID
Other - Middle Name:
Other - Last Name:RYU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:1017 FORT WORTH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75050-5404
Mailing Address - Country:US
Mailing Address - Phone:469-827-7554
Mailing Address - Fax:
Practice Address - Street 1:1017 FORT WORTH ST STE 100
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75050-5404
Practice Address - Country:US
Practice Address - Phone:469-827-7554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-25
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE603999861223G0001X
NMDD39881223G0001X
TX304461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice