Healthcare Provider Details

I. General information

NPI: 1801370366
Provider Name (Legal Business Name): PALISADES PARK DENTAL P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2018
Last Update Date: 09/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 BROAD AVE # 102
PALISADES PARK NJ
07650-1588
US

IV. Provider business mailing address

225 BROAD AVE # 102
PALISADES PARK NJ
07650-1588
US

V. Phone/Fax

Practice location:
  • Phone: 201-461-5580
  • Fax:
Mailing address:
  • Phone: 201-461-5580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: MYUNGSOOK CHOI
Title or Position: MANAGER
Credential:
Phone: 201-321-2354