Provider Demographics
NPI:1356741110
Name:JUNGSUN HWANG DDS PA
Entity type:Organization
Organization Name:JUNGSUN HWANG DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JUNGSUN
Authorized Official - Middle Name:
Authorized Official - Last Name:HWANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:817-421-1104
Mailing Address - Street 1:6407 COLLEYVILLE BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-6279
Mailing Address - Country:US
Mailing Address - Phone:817-421-1104
Mailing Address - Fax:817-421-2006
Practice Address - Street 1:6407 COLLEYVILLE BLVD STE A
Practice Address - Street 2:
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-6279
Practice Address - Country:US
Practice Address - Phone:817-421-1104
Practice Address - Fax:817-421-2006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-29
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX225031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty