Provider Demographics
NPI:1790063816
Name:CHUNG, PHIL W (DDS)
Entity Type:Individual
Prefix:DR
First Name:PHIL
Middle Name:W
Last Name:CHUNG
Suffix:
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 1:3104 BRIDGEBORO RD STE A
Mailing Address - Street 2:
Mailing Address - City:DELRAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08075-9716
Mailing Address - Country:US
Mailing Address - Phone:856-444-5437
Mailing Address - Fax:856-658-1243
Practice Address - Street 1:3104 BRIDGEBORO RD STE A
Practice Address - Street 2:
Practice Address - City:DELRAN
Practice Address - State:NJ
Practice Address - Zip Code:08075-9716
Practice Address - Country:US
Practice Address - Phone:856-444-5437
Practice Address - Fax:856-658-1243
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-22
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0430741223P0221X
NJ22DI028321001223P0221X
MADN18582261223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric Dentistry