Healthcare Provider Details

I. General information

NPI: 1528748571
Provider Name (Legal Business Name): TRI COUNTY ENDODONTICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2023
Last Update Date: 07/24/2023
Certification Date: 07/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

791 PASSAIC AVE
CLIFTON NJ
07012-2802
US

IV. Provider business mailing address

791 PASSAIC AVE
CLIFTON NJ
07012-2802
US

V. Phone/Fax

Practice location:
  • Phone: 973-471-7500
  • Fax: 973-249-1625
Mailing address:
  • Phone: 973-471-7500
  • Fax: 973-249-1625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. JOON PARK
Title or Position: OWNER/ENDODONTIST
Credential: DDS
Phone: 443-465-4065