Provider Demographics
NPI:1982706495
Name:BERCOON, JOAN HILARY (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOAN
Middle Name:HILARY
Last Name:BERCOON
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 1:738 OTAY LAKES RD.
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-6915
Mailing Address - Country:US
Mailing Address - Phone:619-482-9700
Mailing Address - Fax:619-482-9703
Practice Address - Street 1:738 OTAY LAKES RD.
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-6915
Practice Address - Country:US
Practice Address - Phone:619-426-5640
Practice Address - Fax:619-426-1763
Is Sole Proprietor?:No
Enumeration Date:2006-09-04
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA339081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice