Provider Demographics
NPI:1972634590
Name:JUE, EDNA R (DMD)
Entity Type:Individual
Prefix:DR
First Name:EDNA
Middle Name:R
Last Name:JUE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6891 LA PALMA AVE
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90620-2429
Mailing Address - Country:US
Mailing Address - Phone:714-994-6911
Mailing Address - Fax:714-994-6247
Practice Address - Street 1:6891 LA PALMA AVE
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90620-2429
Practice Address - Country:US
Practice Address - Phone:714-994-6911
Practice Address - Fax:714-994-6247
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33599122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist