Provider Demographics
NPI:1730100561
Name:JUNG, ROBERT LOYD I (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LOYD
Last Name:JUNG
Suffix:I
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22400 BARTON RD
Mailing Address - Street 2:8
Mailing Address - City:GRAND TERRACE
Mailing Address - State:CA
Mailing Address - Zip Code:92313-5030
Mailing Address - Country:US
Mailing Address - Phone:909-825-7770
Mailing Address - Fax:909-825-7781
Practice Address - Street 1:22400 BARTON RD
Practice Address - Street 2:8
Practice Address - City:GRAND TERRACE
Practice Address - State:CA
Practice Address - Zip Code:92313-5030
Practice Address - Country:US
Practice Address - Phone:909-825-7770
Practice Address - Fax:909-825-7781
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27895122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist