Provider Demographics
NPI:1780979989
Name:HUH, JANGWON (DMD)
Entity type:Individual
Prefix:
First Name:JANGWON
Middle Name:
Last Name:HUH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 BOSTON RD
Mailing Address - Street 2:STE 201
Mailing Address - City:BILLERICA
Mailing Address - State:MA
Mailing Address - Zip Code:01821-5919
Mailing Address - Country:US
Mailing Address - Phone:617-576-5300
Mailing Address - Fax:
Practice Address - Street 1:790 BOSTON RD
Practice Address - Street 2:STE 201
Practice Address - City:BILLERICA
Practice Address - State:MA
Practice Address - Zip Code:01821-5919
Practice Address - Country:US
Practice Address - Phone:617-576-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-15
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18556681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice