Provider Demographics
NPI:1588782833
Name:YOON, WON MOON (DDS,MS)
Entity type:Individual
Prefix:DR
First Name:WON
Middle Name:MOON
Last Name:YOON
Suffix:
Gender:M
Credentials:DDS,MS
Other - Prefix:DR
Other - First Name:ROBERT
Other - Middle Name:W
Other - Last Name:YOON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS,MS
Mailing Address - Street 1:10740 RED DAHLIA DR
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:MD
Mailing Address - Zip Code:21163-1430
Mailing Address - Country:US
Mailing Address - Phone:410-750-7778
Mailing Address - Fax:
Practice Address - Street 1:8092 EDWIN RAYNOR BLVD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-6833
Practice Address - Country:US
Practice Address - Phone:410-255-0200
Practice Address - Fax:410-360-1747
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD121201223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics