| Organization Name: | ILCHEON JOO DDS PC |
| NPI Number: | 1699006452 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ILCHEON JOO (PRESIDENT/OWNER) |
| Mailing Address: | 46 Mifflin St Pine Grove |
| State: | PA US |
| Postal Code: | 179631318 |
| Phone Number: | 5703453495 |
| Fax Number: | 5703453161 |
| NPI Enumeration Date: | 01/19/2010 |
| NPI Last Update Date: | 01/19/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | DS037775 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |