Provider Demographics
NPI:1871659987
Name:JEAN WOO, DDS, P.A.
Entity Type:Organization
Organization Name:JEAN WOO, DDS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WOO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:850-243-7177
Mailing Address - Street 1:136 STAFF DR NE # B
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32548-5062
Mailing Address - Country:US
Mailing Address - Phone:850-243-7177
Mailing Address - Fax:850-243-4929
Practice Address - Street 1:136 STAFF DR NE # B
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32548-5062
Practice Address - Country:US
Practice Address - Phone:850-243-7177
Practice Address - Fax:850-243-4929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN10017261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental