Healthcare Provider Details

I. General information

NPI: 1730786294
Provider Name (Legal Business Name): JHL DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2020
Last Update Date: 10/07/2020
Certification Date: 10/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 KNICKERBOCKER RD
CRESSKILL NJ
07626-1801
US

IV. Provider business mailing address

210 KNICKERBOCKER RD
CRESSKILL NJ
07626-1801
US

V. Phone/Fax

Practice location:
  • Phone: 201-567-3990
  • Fax:
Mailing address:
  • Phone: 201-567-3990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JOOHYUN LEE
Title or Position: OWNER DENTIST
Credential: DDS
Phone: 631-807-2722