Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 4409 | CT |
NPI | 1063636561 |
---|---|
Provider Name | Dr. Robert W Jung |
First Address | Glastonbury, CT 06033-4205 |
Second Address | Glastonbury, CT 06033-4205 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2007 |
Last Update Date | 08/07/2007 |