Provider Demographics
NPI:1902200611
Name:JEONG, ESTHER BU-DUL (DDS)
Entity Type:Individual
Prefix:DR
First Name:ESTHER
Middle Name:BU-DUL
Last Name:JEONG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:ESTHER
Other - Middle Name:BU-DUL
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1208 E BETHANY DR STE 7
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-3683
Mailing Address - Country:US
Mailing Address - Phone:972-390-8500
Mailing Address - Fax:
Practice Address - Street 1:1208 E BETHANY DR STE 7
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002-3683
Practice Address - Country:US
Practice Address - Phone:972-390-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-09
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30469122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist