Provider Demographics
NPI:1962995134
Name:GWO, JEAN-JEAN (DMD)
Entity type:Individual
Prefix:DR
First Name:JEAN-JEAN
Middle Name:
Last Name:GWO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4416 DELAWARE LN
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-5439
Mailing Address - Country:US
Mailing Address - Phone:469-450-8677
Mailing Address - Fax:
Practice Address - Street 1:6300 STONEWOOD DR STE 210
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-5281
Practice Address - Country:US
Practice Address - Phone:972-596-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-12
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX341631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice