Active NPI
Joshua Mingoo Jeon, DDS
- Dentist
- Fort Bliss, TX
National Provider Identifier
1013893759
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 41809
- Practice address
- 11334 SSG Sims Rd.
Fort Bliss, TX 79908 - Phone
- (915) 742-6083
- NPI assigned
- Aug 15, 2025
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 41809 | TX | Primary |
Addresses
Primary practice location
11334 SSG Sims Rd.
Fort Bliss, TX 79908
Mailing address
11210 Sean Haggerty Dr Apt 18216
El Paso, TX 79934-3451
Phone (808) 347-7412
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 41809 | TX | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1755216000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783555200000",
"number": "1013893759",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11210 SEAN HAGGERTY DR APT 18216",
"city": "EL PASO",
"state": "TX",
"postal_code": "799343451",
"telephone_number": "808-347-7412"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11334 SSG SIMS RD.",
"city": "FORT BLISS",
"state": "TX",
"postal_code": "79908",
"telephone_number": "915-742-6083"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JEON",
"first_name": "JOSHUA",
"middle_name": "MINGOO",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2025-08-15",
"last_updated": "2026-07-09",
"certification_date": "2026-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "TX",
"license": "41809",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Bliss, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.