Provider Demographics
NPI:1740602283
Name:J MAROON DDS INC
Entity Type:Organization
Organization Name:J MAROON DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:MAROON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:858-273-2800
Mailing Address - Street 1:2168 BALBOA AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-4600
Mailing Address - Country:US
Mailing Address - Phone:858-273-2800
Mailing Address - Fax:858-273-2888
Practice Address - Street 1:2168 BALBOA AVE STE 1
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-4600
Practice Address - Country:US
Practice Address - Phone:858-273-2800
Practice Address - Fax:858-273-2888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-17
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA406711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty