Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 0024657 | TX |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 0024657 | TX |
NPI | 1063640316 |
---|---|
Provider Name | Dr. Jonathon Sedrick Jundt |
First Address | Houston, TX 77030-3402 |
Second Address | Houston, TX 77030-3402 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2009 |
Last Update Date | 16/09/2010 |