# ILCHEON JOO DDS PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1699006452
- **Authorized official:** DR. ILCHEON JOO DDS (PRESIDENT/OWNER)
- **Authorized official phone:** (570) 345-3495

## Contact information

- **Practice address:** 46 MIFFLIN ST, PINE GROVE, PA 17963-1318
- **Practice address phone:** (570) 345-3495
- **Practice address fax:** (570) 345-3161
- **Mailing address:** 46 MIFFLIN ST, PINE GROVE, PA 17963-1318
- **Mailing address phone:** (570) 345-3495
- **Mailing address fax:** (570) 345-3161

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | DS037775 | PA | Yes |

## Other

- **Enumeration date:** 01/19/2010
- **Last updated:** 01/19/2010