Provider Demographics
NPI:1740405612
Name:JOHN MAROON DDS A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:JOHN MAROON DDS A PROFESSIONAL CORPORATION
Other - Org Name:JOHN MAROON DDS A PROFESSIONAL CORPORATION
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DENTIST DDS
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:MAROON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-476-1600
Mailing Address - Street 1:310 THIRD AVE
Mailing Address - Street 2:STE C 1B
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910
Mailing Address - Country:US
Mailing Address - Phone:619-476-1600
Mailing Address - Fax:619-476-8280
Practice Address - Street 1:310 THIRD AVE
Practice Address - Street 2:STE C 1B
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910
Practice Address - Country:US
Practice Address - Phone:619-476-1600
Practice Address - Fax:619-476-8280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty