Healthcare Provider Details

I. General information

NPI: 1750041273
Provider Name (Legal Business Name): COLUMBIA BROTHERS DENTAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2021
Last Update Date: 12/23/2021
Certification Date: 12/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 SPOTSWOOD ENGLISHTOWN RD
MONROE NJ
08831-8615
US

IV. Provider business mailing address

410 SPOTSWOOD ENGLISHTOWN RD
MONROE NJ
08831-8615
US

V. Phone/Fax

Practice location:
  • Phone: 732-251-5252
  • Fax:
Mailing address:
  • Phone: 732-251-5252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. JOON SEOK CHO
Title or Position: OWNER/DENTIST
Credential: DDS
Phone: 201-661-4665