Provider Demographics
NPI:1861698466
Name:JEON, JOSHUA JAEKWANG (DDS)
Entity type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:JAEKWANG
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 1:8840 OLD SEWARD HWY STE F
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515
Mailing Address - Country:US
Mailing Address - Phone:907-333-6666
Mailing Address - Fax:907-333-3390
Practice Address - Street 1:8840 OLD SEWARD HWY STE F
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515
Practice Address - Country:US
Practice Address - Phone:907-333-6666
Practice Address - Fax:907-333-3390
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK12391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice