Provider Demographics
NPI:1740341254
Name:JOH, JEAN J (DDS)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:J
Last Name:JOH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 K ST NW STE 575
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20006-1604
Mailing Address - Country:US
Mailing Address - Phone:202-223-3325
Mailing Address - Fax:
Practice Address - Street 1:1625 K ST NW STE 575
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20006-1604
Practice Address - Country:US
Practice Address - Phone:202-223-3325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN10010661223G0001X
NY053078-1122300000X
FLDN18850122300000X
NC9040122300000X
VA0401413124122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist