Healthcare Provider Details

I. General information

NPI: 1306278858
Provider Name (Legal Business Name): 3S ORTHODONTICS, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2013
Last Update Date: 08/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

669 BROAD AVE STE 102
RIDGEFIELD NJ
07657-1631
US

IV. Provider business mailing address

669 BROAD AVE STE 102
RIDGEFIELD NJ
07657-1631
US

V. Phone/Fax

Practice location:
  • Phone: 201-840-1123
  • Fax: 201-840-5699
Mailing address:
  • Phone: 201-840-1123
  • Fax: 201-840-5699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDI19437
License Number StateNJ

VIII. Authorized Official

Name: DR. JINSANG KIM
Title or Position: PRESIDENT
Credential:
Phone: 201-840-1123