Healthcare Provider Details

I. General information

NPI: 1467295220
Provider Name (Legal Business Name): FSH DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2024
Last Update Date: 06/18/2024
Certification Date: 06/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 WALDO AVE
BRONX NY
10463-2223
US

IV. Provider business mailing address

158 ENGLISH ST APT A
FORT LEE NJ
07024-6997
US

V. Phone/Fax

Practice location:
  • Phone: 718-543-3700
  • Fax:
Mailing address:
  • Phone:
  • 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. FRANCIS SANGIK HAN
Title or Position: OWNER
Credential: DDS
Phone: 718-543-3700