Provider Demographics
NPI:1871064162
Name:ESTHER B. JEONG, DDS., PLLC
Entity type:Organization
Organization Name:ESTHER B. JEONG, DDS., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ESTHER
Authorized Official - Middle Name:B
Authorized Official - Last Name:JEONG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-881-0715
Mailing Address - Street 1:1125 W FM 544 STE 700
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-4958
Mailing Address - Country:US
Mailing Address - Phone:972-881-0715
Mailing Address - Fax:972-881-8521
Practice Address - Street 1:1125 W FM 544 STE 700
Practice Address - Street 2:
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-4958
Practice Address - Country:US
Practice Address - Phone:972-881-0715
Practice Address - Fax:972-881-8521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-11
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX345294802Medicaid
TX345294801Medicaid