Provider Demographics
NPI:1730396508
Name:MAROON, JOHN (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:MAROON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1177 BROADWAY
Mailing Address - Street 2:SUITE 19
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-2769
Mailing Address - Country:US
Mailing Address - Phone:619-409-1400
Mailing Address - Fax:619-409-1441
Practice Address - Street 1:1177 BROADWAY
Practice Address - Street 2:SUITE 19
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-2769
Practice Address - Country:US
Practice Address - Phone:619-409-1400
Practice Address - Fax:619-409-1441
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA406711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice