Individual
DR. JUN SOETANTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
11201 SHAKER BLVD, SUITE 136, CLEVELAND, OH 44104-3869
(216) 368-7238
Mailing address
11201 SHAKER BLVD, SUITE 136, CLEVELAND, OH 44104-3869
(216) 368-7238
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
RES 33.79
OH
Other
Enumeration date
07/15/2013
Last updated
07/15/2013
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