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Organization
SB DENTAL LLC
Active
Organization
SB DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAJUNG YOON DMD (CEP)
(718) 309-7310
Entity
Organization
Contact information
Practice address
219 COURTHOUSE RD SE, LOS LUNAS, NM 87031-6811
(505) 865-4341
Mailing address
219 COURTHOUSE RD SE, LOS LUNAS, NM 87031-6811
(505) 865-4341
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
DD4403
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
80133321
—
NM
Enumeration date
10/27/2017
Last updated
10/27/2017
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