Provider Demographics
NPI:1013893759
Name:JEON, JOSHUA MINGOO (DDS)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:MINGOO
Last Name:JEON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11210 SEAN HAGGERTY DR APT 18216
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79934-3451
Mailing Address - Country:US
Mailing Address - Phone:808-347-7412
Mailing Address - Fax:
Practice Address - Street 1:11334 SSG SIMS RD.
Practice Address - Street 2:
Practice Address - City:FORT BLISS
Practice Address - State:TX
Practice Address - Zip Code:79908
Practice Address - Country:US
Practice Address - Phone:915-742-6083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-15
Last Update Date:2025-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX41809122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist