Provider Demographics
NPI:1871669655
Name:JUHLIN, JON (DDS MS)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:
Last Name:JUHLIN
Suffix:
Gender:M
Credentials:DDS MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 CARRIAGE LN
Mailing Address - Street 2:
Mailing Address - City:CEDAR FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50613-1682
Mailing Address - Country:US
Mailing Address - Phone:319-277-7155
Mailing Address - Fax:
Practice Address - Street 1:1810 W 8TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:CEDAR FALLS
Practice Address - State:IA
Practice Address - Zip Code:50613-2056
Practice Address - Country:US
Practice Address - Phone:319-266-7110
Practice Address - Fax:319-266-7112
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA073811223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics