Provider Demographics
NPI:1891943569
Name:JEANETTE Y. SON, DMD PA
Entity Type:Organization
Organization Name:JEANETTE Y. SON, DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEANETTE
Authorized Official - Middle Name:Y
Authorized Official - Last Name:SON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:302-998-8283
Mailing Address - Street 1:2601 ANNAND DR. STE #8
Mailing Address - Street 2:HERITAGE PROFESSIONAL PLAZA
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-3720
Mailing Address - Country:US
Mailing Address - Phone:302-998-8283
Mailing Address - Fax:302-998-7299
Practice Address - Street 1:2601 ANNAND DR. STE #8
Practice Address - Street 2:HERITAGE PROFESSIONAL PLAZA
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-3720
Practice Address - Country:US
Practice Address - Phone:302-998-8283
Practice Address - Fax:302-998-7299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-05
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEG1-0001051122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty