Organization
ILCHEON JOO DDS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ILCHEON JOO DDS (PRESIDENT/OWNER)
(570) 345-3495
Entity
Organization
Contact information
Practice address
46 MIFFLIN ST, PINE GROVE, PA 17963-1318
(570) 345-3495
(570) 345-3161
Mailing address
46 MIFFLIN ST, PINE GROVE, PA 17963-1318
(570) 345-3495
(570) 345-3161
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
DS037775
PA
Other
Enumeration date
01/19/2010
Last updated
01/19/2010
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